Description

Welcome Bonus: $2,500.00 for external candidates (does not apply to rehires)Location: This position is located at our Dublin, OH campus.We’re on a mission to make healthcare simpler and more effective. We fight to ensure our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®. We’re committed to building diverse and inclusive teams, so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.The Registered Nurse (RN) Case Manager - Transplant facilitates care coordination for a member with the potential for a transplant, including hematologic malignancies and end stage disease processes. The position requires a multidisciplinary, collaborative approach to manage the complexity, financial impact, frequent resource utilization and variable acuity across the transplant continuum. Management begins at referral and follows through pre-transplant care, evaluation, the transplant phase to post-transplant case closure.What you’ll do 

• Provide Clinical Care Coordination; Identify and assess members with the potential for solid organ or bone marrow transplant, end stage renal disease and hematologic malignancies.
• Engage telephonically with eligible members and transplant facility case managers to educate on plan structure related to transplant, facility selection, and travel and lodging reimbursement; Perform post discharge calls.
• Provide Utilization Management for Transplant listing requests for identified population. 
• Maintain a working knowledge of all benefit plans and know where to access the needed information.
• Negotiate for services needed if no clear benefit exists or if the services can only be provided out of network. 
• Collaborate with the Stop Loss Carrier and Third Party Administration (TPA) vendors for all Transplant specific language, contracting, and claims payment provisions. 
• Maintain working knowledge of how to secure Transplant Vendor contracts, single case rate agreements, access agreements, and negotiated agreements as required by client plan design.
• Be a clinical resource for all Quantum Health work groups. Work closely with and provide updates to internal client executives and employer contacts for transplant patients. 
• Maintain contact with the Quantum Health clinical staff for transfer of cases when appropriate.
• Participate in new hire, clinical and pod staff training as needed or appropriate.
• All other duties as assigned.

What you’ll bring

• Licensure: Active license in good standing as a Registered Nurse (RN) in Ohio required.
• Education: Bachelor of Science in Nursing (BSN) preferred.
• Certification: Active Certification in Case Management (CCM) preferred.
• Completion of specialized training in Advanced Achievement in Transplant Management (AATMC) or willingness to complete within two years of employment.
• Experience: 2 years of clinical experience with direct patient care required; Proven clinical experience with organ and/or bone marrow transplants, preferred.
• Excellent verbal and written communication skills. Comfortable communicating with members and providers via phone regularly throughout the day.
• Ability to communicate effectively with members and providers in implementing clinical services; Translate complex clinical concepts for non-clinical audiences.
• Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
• Trustworthy and accountable behavior, capable of viewing and maintaining confidential personal information daily.

What’s in it for you

• Compensation: Competitive base pay, incentive plans and employee referral bonuses.
• Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
• Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
• Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
• Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
• Culture: Recognition as a Best Place to Work for 15 years, dedication to , and people-first values that drive every decision.
• Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more! Check out our home:

What you should know

• Internal Associates: Already a Healthcare Warrior? Apply internally through Jobvite.
• Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background Check 
• Diversity, Equity and Inclusion: Quantum Health welcomes everyone. We value our diverse team and suppliers, we’re committed to empowering our ERGs, and we’re proud to be an .
• Agencies: Quantum Health does not accept unsolicited resumes or outreach from third-parties. Absent a signed MSA and request/approval from Talent Acquisition to submit candidates for a specific requisition, we will not approve payment to any third party.
• Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship. 

#LI-HW1 #LI-Hybrid Recruiting Scams: Unfortunately, scams targeting job seekers are common. If you think you’ve encountered a scam, report it to the Federal Trade Commission at and your state’s Attorney General at .To protect our candidates, we want to remind you that authorized representatives of Quantum Health will only contact you from an email address ending in @quantum-health.com. Quantum Health will never ask for personally identifiable information such as Date of Birth (DOB), Social Security Number (SSN), banking/direct/tax details, etc. via email or any other non-secure system, nor will we instruct you to make any purchases related to your employment.Note: Compensation information published by job boards are estimates and not verified by Quantum Health. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate’s unique combination of experience and qualifications related to the position.