15,778 Care Management jobs in the United States
Manager Social Work Care Management
Posted 1 day ago
Job Viewed
Job Description
Location: Chicago, Illinois
Business Unit: Rush Medical Center
Hospital: Rush University Medical Center
Department: Ambulatory Care Management
**Work Type:** Full Time (Total FTE between 0.9 and 1.0)
**Shift:** Shift 1
**Work Schedule:** 8 Hr (8:30:00 AM - 5:00:00 PM)
Rush offers exceptional rewards and benefits learn more at our Rush benefits page ( Range:** $38.02 - $61.88 per hour
Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush's anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.
**Summary:**
The Manager of Social Work Care Management has specialized knowledge, education, and experience in the fields of human behavior, psychology, social work. The Manager is responsible for program development, hiring and staff development, and operational oversight of key programs in the department. The Manager collaborates with a multidisciplinary team as well as both inpatient and outpatient teams to facilitate effective care management, coordination of services at the appropriate level of care, and implement sustainable transition plans. The Manager acts as a role model within the team and is attuned to the cultural needs and health care disparity issues that may be inhibiting patients/caregivers' engagement in their health care. The individual who holds this position exemplifies the Rush mission, vision, and values and acts in accordance with Rush policies and procedures.
**Other information:**
**Required Job Qualifications:**
- Master's Degree in Social Work from an accredited university required.
- Current State of Illinois licensure as a Social Worker, LCSW, required.
- At least two years of experience supervising social workers required.
- At least five years of experience working as an LCSW required.
- Experience related to psychosocial issues, crisis management, conflict resolution, and person-centered
planning and care transitions.
- Skilled educator and communicator. Excellent interpersonal and team building skills, and ability to
collaborate effectively with physicians, nurses, and other staff.
- Process improvement skills, ability to perform tasks independently, prioritize workload, problem-solve,
and analyze data.
- Proficient in the Microsoft Office Suite.
- Demonstrated effective problem solving skills in a health care setting, preferably an academic medical
center
- Demonstrates the ability to address psychosocial barriers that are inhibiting a patient's adherence to
managing medical recommendations needed to achieve good health outcomes.
- Ability to travel throughout the Medical Center.
**Responsibilities:**
Job **Responsibilities:**
- Responsible for managing staff with complex patient caseloads.
- Advocates for patient/family/caregiver needs and facilitates referrals for continuity of care. Provides crisis
intervention when needed.
- Provides leadership, support and clinical expertise within inpatient and ambulatory Care Management
teams to achieve desired outcomes.
- Responsible for maintaining policies and procedures, develops and updates guidelines and/or survival
manuals on clinical area specific CM tasks, and functions as a super user for EPIC training and
development.
- Assists in program development and process improvement.
- Collaborates in complex cases that are escalated to management in order to provide proactive care
planning, coordinated transition plans, and implements readmission avoidance strategies.
- Serves as a resource to physicians, nurses, peers, and care management staff in managing complex cases
and resolving issues.
- Provides leadership and facilitates communication between the ambulatory and inpatient settings to
ensure effective and sustainable care transitions from hospital to home and care plans within community
care settings.
- Supports team education and training functions related to complex psychosocial issues and transitions in
care coordination.
- Conducts education for staff including social work and nurse care managers, patient care navigators,
physicians, and allied health professionals as requested.
- Coordinates interdisciplinary conferences, serves on committees, and leads work groups to address
psychosocial/care coordination issues.
- Maintains relationships with referring Rush clinics through consistent and timely communication.
- Contributes to program and goal development and best practice standards.
- Models and maintains a quality-based, patient-centered approach to achieve department and institutional
goals and process improvements.
- Supports customer satisfaction among persons, families, physicians, external case managers, payers,
vendors, and inpatient staff.
- Participates in research to evaluate project initiatives. Applies evidenced based practice.
- Other duties as assigned.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
**Position** Manager Social Work Care Management
**Location** US:IL:Chicago
**Req ID** 19214
Medical Social Work - Care management
Posted 15 days ago
Job Viewed
Job Description
Hiring Bonus and Relocation Assistance may be available!
PeaceHealth is seeking a Care Management/Medical Social Work for a Full Time, 0.90 FTE, Variable position. The salary range for this job opening at PeaceHealth is $37.30 - $55.92. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.
**Job Summary**
Responsible for identifying and interacting with medically and psychosocially complex patients and families who are likely to benefit from care management and meet high risk criteria and for coordination of discharge planning services for these patients in collaboration with RN Care Management and other members of the care team.
Details of the position
+ Screen and identify patients who need care management per high-risk criteria.
+ Assess, develop, implement and monitor a comprehensive discharge plan of care through an interdisciplinary team process in conjunction with the patient and family. Collaborate with the multi-disciplinary team to identify problems or needs that require special planning, intervention, teaching or follow-up.
+ Identify key problems, strengths and resources to be addressed in the discharge plan of care. Coordinate and facilitate improved ability to comply with plan of treatment; counseling or support needed to cope with situation; improved ability to access appropriate level of care due to lack of financial resources or lack of available service.
+ Actively support measures that promote effective use of resources.
+ Identify, plan and arrange for appropriate services applying a knowledge of services available in the community, state, and federal health regulations and admission, discharge and appropriate level of care. Coordinate effective planning and arranging for needed services upon discharge.
+ Intervene by arranging services, education and providing psychosocial support to prepare the patient and their family to manage their healthcare needs within the acute care setting and post discharge.
+ Coordinate with the interdisciplinary team and community resources when appropriate, regarding the multiple details of transitional care management plan. Consult with physician as indicated.
+ Works with patients identified and referred to them by RN Care Management and/or other members of the care team, as well as by patients/families.
+ Conducts evaluation to include appropriate documentation and the effectiveness of the Care Management services. Collaborates with team members to identify cause and adjust plan if patient's health status is not improving.
+ May counsel patients and/or families to facilitate and/or participate in community care services, in coordination with the physician and treatment team. Works as an integral member of the treatment team in the coordination of treatment and transition of care planning. Assesses and addresses both mental health and chemical dependency conditions. May perform risk assessments for suicidality and homicidality.
+ Performs other duties as assigned.
What you bring
+ Bachelor's Degree Required: Social Work or related field with a minimum of four years' work experience in a medical or healthcare setting, social service agency, or community organization focusing on health and/or welfare issues. Critical Access Hospital ONLY _or_
+ Master's Degree Required: Social Work or related field _or_
+ Master's Degree Required: Counseling or related field
+ Minimum of 2 years Preferred: Employment in a healthcare setting or community agency dealing with health and/or welfare issues
+ May be required: Basic Life Support
+ Preferred: Certified Case Manager
+ Required within 90 Days: Counselor Agency Affiliate _or_
+ Required Upon Hire: Washington State Social/Counseling Work Credential
_For a full description of the position, or for questions, please contact Moussa Sangare at
PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.
See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility ( .
For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.
REQNUMBER: 110840
Medical Social Work - Care Management
Posted 15 days ago
Job Viewed
Job Description
PeaceHealth is seeking a Care Management/Medical Social Work for a Per Diem/Relief, 0.00 FTE, Variable position. The salary range for this job opening at PeaceHealth is $37.30 - $55.92. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.
**Job Summary**
Responsible for identifying and interacting with medically and psychosocially complex patients and families who are likely to benefit from care management and meet high risk criteria and for coordination of discharge planning services for these patients in collaboration with RN Care Management and other members of the care team.
Details of the position
+ Screen and identify patients who need care management per high-risk criteria.
+ Assess, develop, implement and monitor a comprehensive discharge plan of care through an interdisciplinary team process in conjunction with the patient and family. Collaborate with the multi-disciplinary team to identify problems or needs that require special planning, intervention, teaching or follow-up.
+ Identify key problems, strengths and resources to be addressed in the discharge plan of care. Coordinate and facilitate improved ability to comply with plan of treatment; counseling or support needed to cope with situation; improved ability to access appropriate level of care due to lack of financial resources or lack of available service.
+ Actively support measures that promote effective use of resources.
+ Identify, plan and arrange for appropriate services applying a knowledge of services available in the community, state, and federal health regulations and admission, discharge and appropriate level of care. Coordinate effective planning and arranging for needed services upon discharge.
+ Intervene by arranging services, education and providing psychosocial support to prepare the patient and their family to manage their healthcare needs within the acute care setting and post discharge.
+ Coordinate with the interdisciplinary team and community resources when appropriate, regarding the multiple details of transitional care management plan. Consult with physician as indicated.
+ Works with patients identified and referred to them by RN Care Management and/or other members of the care team, as well as by patients/families.
+ Conducts evaluation to include appropriate documentation and the effectiveness of the Care Management services. Collaborates with team members to identify cause and adjust plan if patient's health status is not improving.
+ May counsel patients and/or families to facilitate and/or participate in community care services, in coordination with the physician and treatment team. Works as an integral member of the treatment team in the coordination of treatment and transition of care planning. Assesses and addresses both mental health and chemical dependency conditions. May perform risk assessments for suicidality and homicidality.
+ Performs other duties as assigned.
What you bring
+ Bachelor's Degree Required: Social Work or related field with a minimum of four years' work experience in a medical or healthcare setting, social service agency, or community organization focusing on health and/or welfare issues. Critical Access Hospital ONLY _or_
+ Master's Degree Required: Social Work. or related field _or_
+ Master's Degree Required: Counseling. or related field
+ Required within 90 Days: Counselor Agency Affiliate (Applied for or received) _or_
+ Required Upon Hire: Washington State Social/Counseling Work Credential
_For a full description of the position, or for questions, please contact Moussa Sangare at
PeaceHealth is committed to the overall wellbeing of our caregivers. The benefits included in positions less than 0.5 FTE are 403b retirement plan for caregiver contributions; wellness benefits, discount program, and expanded EAP and mental health program.
See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility ( .
For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.
REQNUMBER: 99418
Care Management
Posted 1 day ago
Job Viewed
Job Description
Immediate need for a talented Care Management. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:25-71237
Pay Range: $22 - $24/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Works hard to collaborate with our internal medical director and clinical nursing to get peer to peer schedules to get authorizations approved for member svcs being requested.
- Supports administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines.
- (TBD)
- Needed for high call volume to fulfil service levels.
- Possibly, later in the year by September (TBD).
- In a live call que while navigating multiple systems scheduling peer to peer requests for our internal medical providers.
- All communications levels (Teams chats, emails, etc).
- Fast paced w/ high call volume; fluent process with how to get requests completed, cooperative, collaborative with leaders highly involved with processes.
- Assisting providers and members getting authorizations overturned.
- Works hard to collaborate with our internal medical director and clinical nursing to get peer to peer schedules to get authorizations approved for member svcs being requested.
- In comparison to other teams/LOBS/markets we are very competitive.
- Would gain self-confidence in overall communication w/ internal team and members, how to navigate through systems, as well as gaining experience with quickly adapting to change with the processes.
- Key Skills:Trucare experience, , Medical Insurance, Member outreach, Calling, Call center experience,
- High school diploma or GED.
- Call center experience, Medical Insurance experience, Customer service, Problem solving skills.
- Trucare experience and phone system experience
- Disqualifiers: Not having a quiet place to take live calls and poor internet quality/speed.
- Performance indicators: Average handle time, Average hold time
- Best vs. average: Average Handle time of : 7 minutes vs 7.5 minutes
- Average hold time: 1 minutes vs 1.5 minutes.
- Customer Service
- Medical Insurance.
- Communication skills.
- Must have great organizational skills and easily coachable.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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#prof
Director Care Management
Posted today
Job Viewed
Job Description
Description
Calling All Healthcare Visionaries!
Are you a dynamic leader with a passion for transformative healthcare delivery? Do you excel at navigating intricate challenges and driving change? If so, we have the perfect opportunity for you!
The Role: Under the supervision of the North Division Executive Director of Care Management, the Director of Care Management is a pivotal role responsible for orchestrating and optimizing care management. You will lead and inspire a dedicated team, ensuring a seamless continuum of care, patient advocacy, and efficient resource management from admission through to discharge. This role is integral in maintaining financial viability by overseeing care management teams to coordinate the best next site of care for our patients.
This position oversees St. Peter Hospital (390 beds) and Centralia Hospital (128 beds).
What You'll Do:
- Master Coordinator: Direct, coordinate, and facilitate care management processes to ensure the highest standard of patient care and operational efficiency.
- Champion of Continuity and Care Coordination: Oversee the delivery of consistent and expected clinical outcomes, advocate for patients, and manage resources effectively to minimize fragmentation within the healthcare delivery system.
- Communication Facilitator: Ensure robust communication amongst all members of the healthcare team, fostering an environment of collaboration to enhance patient care.
- Cultural Advocate: Promote cultural and religious sensitivity, ensuring patient care respects diverse beliefs and backgrounds.
Essential Functions:
- Mission-Driven Leadership: Ensure team alignment with the organization’s Mission, Vision, and Core Values.
- Customer Satisfaction: Develop and maintain a comprehensive departmental customer satisfaction program.
- Human Resource Management: Attract and retain top talent, coach, and manage staff to achieve peak performance.
- Compliance and Confidentiality: Adhere to infection control, risk management, confidentiality policies, and regulatory guidelines.
- Cultural Competency: Foster a respectful environment that is sensitive to cultural and religious diversity.
- Safety and Security: Ensure compliance with all safety and security policies and procedures.
- Patient-Centric Care: Provide competent care tailored to diverse patient populations, including neonates, pediatrics, adolescents, adults, and older adults.
- Policy Development: Contribute to the creation and maintenance of departmental policies in line with organizational, legal, and community standards.
- Goal Setting: Assist in setting departmental goals that align with organizational strategies.
- Budget Management: Participate in annual budget planning to deliver cost-effective and high-quality services.
- Admission and Discharge Management: Oversee admission and discharge services, ensuring alternatives are considered for non-qualifying inpatient admissions.
- Physician Relations: Build strong cooperative relationships with physicians.
- Utilization Management Oversight: Lead the Utilization Management Committee, ensuring effective use of resources and monitoring data trends.
- Contract Management: Supervise services provided by external partners, maintaining high service standards.
- Referral Agency Coordination: Establish and maintain relationships with external agencies to facilitate timely patient discharges.
What You'll Bring:
- Educational Background: Bachelor’s Degree in Nursing; Master’s Degree preferred.
- Clinical Experience: At least 2 years as an RN in an acute care setting.
- Leadership Experience: Minimum 3 years managing care coordination. Utilization review knowledge preferred.
- Independent Leadership: Proven ability to work independently and lead teams to achieve objectives.
- Systemic Thinking: Expertise in applying system thinking to identify and solve problems efficiently.
Why Join Us?
- Impactful Work: Contribute to meaningful change in healthcare delivery, improving countless lives.
- Professional Growth: Leverage your autonomy and our support to innovate and excel.
- Collaborative Excellence: Work with a team of dedicated, talented professionals passionate about healthcare.
- Dynamic Environment: Thrive in a fast-paced, evolving industry.
- Vibrant Community: Enjoy the unique cultural and natural beauty of our location.
Ready to Shape the Future of Healthcare? If you are a visionary leader with a passion for healthcare, we encourage you to apply! Join our team and help us create a healthier future for all.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Requsition ID: 351392
Company: Providence Jobs
Job Category: Care Management
Job Function: Clinical Care
Job Schedule: Full time
Job Shift: Day
Career Track: Leadership
Department: 3030 CASE MGMT WA SPH
Address: WA Olympia 413 Lilly Rd NE
Work Location: Providence St Peter Hospital-Olympia
Workplace Type: On-site
Pay Range: $71.15 - $112.34
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Director Care Management
Posted today
Job Viewed
Job Description
Description
Calling All Healthcare Visionaries!
Are you a dynamic leader with a passion for transformative healthcare delivery? Do you excel at navigating intricate challenges and driving change? If so, we have the perfect opportunity for you!
The Role: Under the supervision of the North Division Executive Director of Care Management, the Director of Care Management is a pivotal role responsible for orchestrating and optimizing care management. You will lead and inspire a dedicated team, ensuring a seamless continuum of care, patient advocacy, and efficient resource management from admission through to discharge. This role is integral in maintaining financial viability by overseeing care management teams to coordinate the best next site of care for our patients.
This position oversees St. Peter Hospital (390 beds) and Centralia Hospital (128 beds).
What You'll Do:
- Master Coordinator: Direct, coordinate, and facilitate care management processes to ensure the highest standard of patient care and operational efficiency.
- Champion of Continuity and Care Coordination: Oversee the delivery of consistent and expected clinical outcomes, advocate for patients, and manage resources effectively to minimize fragmentation within the healthcare delivery system.
- Communication Facilitator: Ensure robust communication amongst all members of the healthcare team, fostering an environment of collaboration to enhance patient care.
- Cultural Advocate: Promote cultural and religious sensitivity, ensuring patient care respects diverse beliefs and backgrounds.
Essential Functions:
- Mission-Driven Leadership: Ensure team alignment with the organization’s Mission, Vision, and Core Values.
- Customer Satisfaction: Develop and maintain a comprehensive departmental customer satisfaction program.
- Human Resource Management: Attract and retain top talent, coach, and manage staff to achieve peak performance.
- Compliance and Confidentiality: Adhere to infection control, risk management, confidentiality policies, and regulatory guidelines.
- Cultural Competency: Foster a respectful environment that is sensitive to cultural and religious diversity.
- Safety and Security: Ensure compliance with all safety and security policies and procedures.
- Patient-Centric Care: Provide competent care tailored to diverse patient populations, including neonates, pediatrics, adolescents, adults, and older adults.
- Policy Development: Contribute to the creation and maintenance of departmental policies in line with organizational, legal, and community standards.
- Goal Setting: Assist in setting departmental goals that align with organizational strategies.
- Budget Management: Participate in annual budget planning to deliver cost-effective and high-quality services.
- Admission and Discharge Management: Oversee admission and discharge services, ensuring alternatives are considered for non-qualifying inpatient admissions.
- Physician Relations: Build strong cooperative relationships with physicians.
- Utilization Management Oversight: Lead the Utilization Management Committee, ensuring effective use of resources and monitoring data trends.
- Contract Management: Supervise services provided by external partners, maintaining high service standards.
- Referral Agency Coordination: Establish and maintain relationships with external agencies to facilitate timely patient discharges.
What You'll Bring:
- Educational Background: Bachelor’s Degree in Nursing; Master’s Degree preferred.
- Clinical Experience: At least 2 years as an RN in an acute care setting.
- Leadership Experience: Minimum 3 years managing care coordination. Utilization review knowledge preferred.
- Independent Leadership: Proven ability to work independently and lead teams to achieve objectives.
- Systemic Thinking: Expertise in applying system thinking to identify and solve problems efficiently.
Why Join Us?
- Impactful Work: Contribute to meaningful change in healthcare delivery, improving countless lives.
- Professional Growth: Leverage your autonomy and our support to innovate and excel.
- Collaborative Excellence: Work with a team of dedicated, talented professionals passionate about healthcare.
- Dynamic Environment: Thrive in a fast-paced, evolving industry.
- Vibrant Community: Enjoy the unique cultural and natural beauty of our location.
Ready to Shape the Future of Healthcare? If you are a visionary leader with a passion for healthcare, we encourage you to apply! Join our team and help us create a healthier future for all.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Requsition ID: 351392
Company: Providence Jobs
Job Category: Care Management
Job Function: Clinical Care
Job Schedule: Full time
Job Shift: Day
Career Track: Leadership
Department: 3030 CASE MGMT WA SPH
Address: WA Olympia 413 Lilly Rd NE
Work Location: Providence St Peter Hospital-Olympia
Workplace Type: On-site
Pay Range: $71.15 - $112.34
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Manager, Care Management
Posted today
Job Viewed
Job Description
The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
This is a remote position and will require 50% travel in Wayne County or Macomb County.
Must reside in Michigan with capability to drive to Wayne County or Macomb County.
The Manager, Care Management oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.
The Manager of Care Management
- Requires cross-departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
- Responsible for and oversees delivery of care to all members served by the location.
- Reviews available information related to the member’s case, including disciplines required, to determine assessment needs.
- Monitor performance of staff including service performance and adherence to established care coordination benchmarks.
- Identify members for specific case management and / or disease management activities.
- Develop audit plans and tools for teams to ensure compliance with state contract on performance metrics and to ensure member needs are met.
- Develops reporting tools in collaboration with leadership to identify clinical performance.
- Responsible for interviewing, hiring, coaching, evaluating, and mentoring a diverse care coordination work force.
- Onboard new staff including but not limited all pre-employment human resource tasks, ordering of software, hardware, supplies and support technologies.
- Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions.
Use your skills to make an impact
Required Qualifications
- Must reside in Michigan and be able to travel to Wayne County or Macomb County.
- Active Registered Nurse (RN) license or Social Work (SW) license in the state of Michigan
- Minimum education of an Associate's Degree
- Minimum 5 years of professional experience as a licensed RN or Social Worker to include experience in case and/or disease management
- Minimum 2 years of management experience with at least 1 year of management experience in a home care, hospice or equivalent field-based environment
- Proven ability providing supporting Clinicians well-being and building resilience when faced with challenges
- Proficiency in analyzing and interpreting data trends.
- Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
- Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work
- This role is part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$5,000 bodily injury per event / 10,000 for property damage or whichever is higher.
- This role is considered member facing and is part of Humana Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Preferred Qualifications
- Certified Case Manager (CCM)
- Previous experience working in a managed care field
- 5 or more years of previous management/supervisor level experience
- Experience with Medicaid Long Term Care
- Bilingual (fully fluent) in English and Spanish
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Additional Information
- Workstyle: This is a remote- field position where employees perform their core duties from a home office with travel as needed to support Field Clinicians
- Travel: 50 - 75% field interactions in Wayne County or Macomb County.
- Workdays and Hours: Core hours are Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (CST) as well as occasional weekend hours, as needed, to support the business
- Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
Interview Format
If selected to move forward for screening and/or interviewing, you will receive communications from our HireVue technology platform which allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience and enhance our hiring and decision-making ability.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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Manager, Care Management
Posted today
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Job Description
The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
This is a remote position and will require 50% travel in Wayne County or Macomb County.
Must reside in Michigan with capability to drive to Wayne County or Macomb County.
The Manager, Care Management oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.
The Manager of Care Management
- Requires cross-departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
- Responsible for and oversees delivery of care to all members served by the location.
- Reviews available information related to the member’s case, including disciplines required, to determine assessment needs.
- Monitor performance of staff including service performance and adherence to established care coordination benchmarks.
- Identify members for specific case management and / or disease management activities.
- Develop audit plans and tools for teams to ensure compliance with state contract on performance metrics and to ensure member needs are met.
- Develops reporting tools in collaboration with leadership to identify clinical performance.
- Responsible for interviewing, hiring, coaching, evaluating, and mentoring a diverse care coordination work force.
- Onboard new staff including but not limited all pre-employment human resource tasks, ordering of software, hardware, supplies and support technologies.
- Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions.
Use your skills to make an impact
Required Qualifications
- Must reside in Michigan and be able to travel to Wayne County or Macomb County.
- Active Registered Nurse (RN) license or Social Work (SW) license in the state of Michigan
- Minimum education of an Associate's Degree
- Minimum 5 years of professional experience as a licensed RN or Social Worker to include experience in case and/or disease management
- Minimum 2 years of management experience with at least 1 year of management experience in a home care, hospice or equivalent field-based environment
- Proven ability providing supporting Clinicians well-being and building resilience when faced with challenges
- Proficiency in analyzing and interpreting data trends.
- Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
- Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work
- This role is part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$5,000 bodily injury per event / 10,000 for property damage or whichever is higher.
- This role is considered member facing and is part of Humana Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Preferred Qualifications
- Certified Case Manager (CCM)
- Previous experience working in a managed care field
- 5 or more years of previous management/supervisor level experience
- Experience with Medicaid Long Term Care
- Bilingual (fully fluent) in English and Spanish
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Additional Information
- Workstyle: This is a remote- field position where employees perform their core duties from a home office with travel as needed to support Field Clinicians
- Travel: 50 - 75% field interactions in Wayne County or Macomb County.
- Workdays and Hours: Core hours are Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (CST) as well as occasional weekend hours, as needed, to support the business
- Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
Interview Format
If selected to move forward for screening and/or interviewing, you will receive communications from our HireVue technology platform which allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience and enhance our hiring and decision-making ability.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Nurse, Care Management
Posted today
Job Viewed
Job Description
Summary
SUMMARY: Responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients; develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, and identifies cost-effective protocols. Care Management provides Care Coordination, Compliance, Transition Coordination, and Utilization Management.
DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.
1. Coordinates all utilization review functions, including response to payor requests for concurrent and retrospective review information including Medicare and MediCal regulations/requirements, avoidable days and quality issues. Applies Medical necessity criteria to determine level of care.
2. Assures clinical interventions are appropriate for the admitting diagnosis and Level of Care that reflects the standard of care, as defined by the medical staff and the organization; identify inappropriate admit status based on identified criteria and ensures the patient is registered at the appropriate level of care. Utilizes McKesson Interqual® clinical guidelines; refers questionable cases to the CM Manager or physician advisor for determination.
3. Takes appropriate action when cases do not meet criteria. Escalates to the attending physician, and the Care Management physician advisor of any concurrent denials.Prepares case reports;documents treatment plan, progress notes and discharge summary related information as required by Medicare, MediCal, Title 22 and other mandated regulations according to Department standards.Reassesses the patient’s condition when changes occur and revises the care plan when appropriate.
4. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social work, and other healthcare providers and agencies. Completes an initial assessment within 24 hours of admission and documents findings in the electronic health record. Processes referrals and authorizations that adhere to federal, state and local insurance regulatory agencies and offer patient choice per regulation.
5. Identifies potential problems prevents and or resolves barriers to the discharge plan. Along with the social work team member
6. Mobilize resources to effect rapid and timely movement of the patient through system to achieve targeted discharge times established by AHS.
7. Identifies and mobilizes patients and family strengths to optimize use of healthcare and community resources. In coordination with patient and family wishes, guide/assist in securing needed post discharge services
8. Collaborates with Care Management teams (i.e. Care Transition team and CM teams at other facilities) for high risk patients for timely follow-up appointments and confirms prior to discharge that complex patients are appropriately linked to community services.
9. Provides community resource education and coaching, focusing on individual patient self-management principles. Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient.
10. Communicates with physicians and multidisciplinary health team members to provide continuity of care, supporting and maintaining the multidisciplinary team approach to ensure effective resource utilization and appropriate level of care.
11. Makes independent assessments and recommendations regarding course of action in complex situations.
12. Confirm all applicable department and regulatory targets for department performance process improvements are attained (e.g., re admissions, throughput, LOS).
MINIMUM QUALIFICATIONS:
Required Education: Associate Degree in Nursing
Preferred Education: Bachelor’s of Nursing
Preferred Education: Master’s in Nursing
Required Experience: Three years of acute care nursing
Preferred Experience : Medical/surgical or critical care experience; broad clinical background. Within the last 3 years, experience in Case Management in an acute setting or utilization review at a medical group or health plan.
Required Licenses/Certifications : Active licensure as a Registered Nurse in the State of California, Active BLS - Basic Life Support Certification issued by the American Heart Association; other advanced life support certifications may be required per unit/department specialty according to patient care policies; CPI -Crisis Prevention Intervention Training (required for all positions at John George Psychiatric Pavilion; and certain positions in the Emergency Department).
Preferred Licenses/Certifications: Certification in Case Management, CCMC or ACM. Bilingual Preferred.
PAY RANGE: $77.67 - 113.98/HR
The pay range for this position reflects the base pay scale for the role at Alameda Health System. Final compensation will be determined based on several factors, including but not limited to a candidate’s experience, education, skills, licenses and certifications, departmental equity, applicable collective bargaining agreements, and the operational needs of the organization. Alameda Health System also offers eligible positions a generous comprehensive benefits program.
Highland General Hospital
HGH Care Coordination
Part Time
Day
Care Management
FTE: 0.8
Care Management Specialist
Posted 1 day ago
Job Viewed
Job Description
Summary
SUMMARY: Assists in Care Management Team of social workers and nurses with functions such as but not limited to provide census reconciliation, administrative support for care coordination and discharge planning activities, working with the payors, accurate and critical information data entry and tracking, and report creation.
DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE : The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.
1. Functions as a key point of contact between clinical case management staff, admissions and payors. Documents all interactions with payors and communicates status with Care Management staff.
2. Coordinates and obtains authorizations for admissions; documents all information in the AHS financial system; works closely with Revenue Cycle to ensure each inpatient encounter is accurate; coordinates all reviews and inquires with the payors.
3. Reconciles census; works with Patient Access and the Care management team to ensure census is correct in the financial and care management systems; prepares paperwork and updates encounter information for admissions, discharges and transfers of patients; prepares census for the Care Management staff.
4. Collaborates with Case Management staff to provide specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post discharge services.
5. Per the direction of the Care Management social worker and/or nurse, facilitates, identifies and documents all referrals made to contracted facilities, providers or agencies, makes post discharge appointments for patients and coordinates transportation; expedites discharges by transmitting appropriate documentation to providers for acceptance of patient; documents all interactions with payers and communicates status with appropriate staff.
6. Manages multiple inquiries and presents referral based on location and services provided; appropriate follow up on active or pending inquires.
7. Coordinates with referral sources on bed availability, new product and services; maintains current database of existing and potential referral sources.
8. Communicates status with Care Management staff and arranges for patient transfer; functions as a key point of contact between Care Management staff, admissions and payers.
9. Coordinate and track any communication, e.g. Important Message (IM) letters, Denial Letters, patient choice forms; regularly updates Care Management team.
10. Supports any audits with coordinating medical records with HIM; prepares statements of diagnosis and treatments, and extracts other information required for the completion of forms received from patients' insurance carriers.
11. Perform all other duties as assigned.
MINIMUM QUALIFICATIONS:
Required Education : High School Diploma or G.E.D.
Preferred Education : Bachelor's degree in related field.
Required Experience : One year experience in a case management specialist position in an acute care setting.
Required Experience : Three years in a health care field or one year in Utilization Management at a Medical Group or Health plan experience; electronic Health Record (EHR) and Case Management applications, e.g. Midas or 3M.
Preferred Experience : Medical Assistant.
PAY RANGE: $45.56/HR
The pay range for this position reflects the base pay scale for the role at Alameda Health System. Final compensation will be determined based on several factors, including but not limited to a candidate’s experience, education, skills, licensure and certifications, departmental equity, applicable collective bargaining agreements, and the operational needs of the organization. Alameda Health System also offers eligible positions a generous comprehensive benefits program.
Highland General Hospital
HGH Care Coordination
Services As Needed / Per Diem
Day
Care Management
FTE: 0.01