DescriptionLocation: This position is located at our Dublin, OH campus.Multistate Licensure: Quantum Health nurses must be willing and able to obtain and maintain nursing licensure in multiple states, as required by the business. All application and filing fees will be paid by Quantum Health.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.High Cost Case nurses continually initiate, monitor, update, and identify cases for high cost management and reporting. Through all avenues of care coordination, members are identified who are at risk for or have incurred high cost medical care. HCC nurses will also review complex cases such as muscular dystrophy, cancers, AIDS, and autoimmune disorders.What you'll doEvaluate appropriately identified members for cost containment strategies such as network utilization, Site of Care opportunities, external vendors, appropriate precertification, and clinical engagementLeveraging clinical expertise to assess standards of care in relation the high cost driver. The nurse will review the treatment plan to ensure there is a defined care path. This includes Case Management and Disease Management opportunities and care gaps, as well as Utilization Management opportunities including readmissions, Site of Care, and ER utilizationCreate a case summary based on the case history, current state, and future needs including estimated costs and future cost analysis.Reevaluate cases on a cyclical basis based on new clinical needs, claims, and other relevant data.Manage stop loss clinical information requests via the email boxAddress CEG questions, clinical requests, and client specific needs on an ad hoc basis.Collaboratively work with all aspects of Care Coordinators at Quantum Health to ensure the highest level of quality and care.All other duties as assigned.What you'll bringEducation / Licensure: Active license in good standing as Licensed Practical Nurse (LPN) in the state of OhioValid, unrestricted license in state of OhioAptitude to research and identify issues using critical thinkingDriven to work independently with limited need for daily supervisionUtilize nursing judgment to ensure timely and thoughtful decisions, focused on achieving results consistent with business goals and organization culture.Perform as a team member with the working group, interact professionally with other entities both internally and externally.Proactively present issues and ask questionsProficiency with computer skills, navigating multiple systems, and Microsoft applicationsAbility to multitask, prioritize and effectively adapt to a fast-paced changing environmentEffective communication skills, both verbal and written.Protect and take care of our company and member's data every day by committing to work within our company ethics and policiesStrong 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 information daily.What's in it for youCompensation: 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.R