Medicare Regional Sales & Service Specialist

Medical Mutual of Ohio

Under general supervision, applies an in depth understanding of health insurance benefits to evaluate and provide support to members, their families, and physicians in addressing member needs. Educates members and families to make informed personal health care decisions and determines the most effective treatment options. Facilitates communication between member, physician and community.

  • Manages health care cases by phone. Verifies eligibility, enrollment history and demographics. Assesses patient needs by gathering information from the member, family, provider and other stakeholders. Utilizes clinical expertise and applies corporate standards of practice in educating members and determining appropriate treatment options.
  • Facilitates and implements interventions based on agreed upon care treatment plan developed in collaboration with all stakeholders.
  • Monitors and evaluates services for medical appropriateness and quality of care.
  • Maintains appropriate documentation within Company and regulatory guidelines.
  • Coordinates services with community resources and support groups with members.
  • Collaborates with utilization management in authorizing services.
  • Keeps up to date on care management regulations, policies and practices.
  • Performs other duties as assigned.


  • Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor’s Degree preferred.
  • 3 years as a Registered Nurse with a combination of clinical and case management experience, preferably in the health insurance industry.
  • Home health care experience is a plus.
  • Certified Case Manager (CCM) or other industry recognized certification (required to complete within 3 years of hire).
  • Registered Nurse with current State of Ohio unrestricted license.
  • Certification in Motivational Interviewing preferred.
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:
  • Top Workplace in Northeast Ohio. Year after year we’ve received this recognition!
  • On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
  • On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
  • Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
  • Business casual attire
Excellent Benefits and Compensation:
  • Competitive compensation plans
  • Employee bonus program
  • 401(k) with company match and an additional company contribution
  • Excellent medical, dental, vision, and disability insurance
An Investment in You:
  • Career development programs and classes
  • Mentoring and coaching to help you advance
  • Education reimbursement up to $5K per year
About Medical Mutual:
We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We’re the largest health insurer in Ohio and for over 80 years, we’ve been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!
At Medical Mutual we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Primary Location
: US-OH-Cleveland

Other Locations
: US-OH-Toledo

Work Locations
: Cleveland – Headquarters 2060 East Ninth Street Cleveland 44115

: 7 – General Staff

: Managed Care

: Regular

: Standard

Employee Status
: Individual Contributor

Job Type
: Full-time

Job Level
: Day Job

Job Posting
: May 17, 2019, 1:18:24 PM

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