Utilization Management Representative I

Midtown Atlanta, Georgia Elevance Health

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**Utilization Management Representative I**
**Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
The **Utilization Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review.
**How you will make an impact:**
+ Managing incoming calls or incoming post services claims work.
+ Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
+ Refers cases requiring clinical review to a Nurse reviewer.
+ Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
+ Responds to telephone and written inquiries from clients, providers and in-house departments.
+ Conducts clinical screening process.
+ Authorizes initial set of sessions to provider.
+ Checks benefits for facility based treatment.
+ Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
**Minimum Requirements**
+ HS diploma or GED
+ Minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
**Preferred Skills, Capabilities and Experiences**
+ Medical terminology training and experience in medical or insurance field preferred.
?URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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Analyst Case Management

30309 Midtown Atlanta, Georgia CVS Health

Posted today

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Job Description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Program Summary**
Join our Aetna care management team as we lead the way in providing exceptional care to dual eligible populations! You will have a life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid. As a member of the care team, you will collaborate with members, the internal care team, healthcare providers, and community organizations to meet the complex healthcare and social needs of our members Be part of this exciting opportunity as we expand our DSNP services to transform lives in new markets across the country.
**Position Summary/Mission**
As a vital member of our Special Needs Plan (SNP) care team, the Care Coordinator (CC) is responsible for coordinating care for our members through close collaboration with the Care Manager, Social Worker, and other interdisciplinary team members. This role involves evaluating member needs through the annual Health Risk Survey, addressing social determinants of health (SDoH), coordinating care across the continuum, and closing gaps in preventive and health maintenance care.
**Key Responsibilities**
+ **Member Evaluation:** Conduct the annual Health Risk Survey to support needs identification for the member's Individual Plan of Care.
+ **Risk Escalation:** Inform the assigned care manager of newly identified health/safety risks or service needs
+ **Care Coordination:** Complete care coordination activities delegated by the care manager within an established timeframe.
+ **Quality Issue Escalation:** inform the assigned care manager and/or associate manager of any identified quality of care issues.
+ **Advocacy:** Passionately support the member's care coordination needs and drive solutions to address those needs.
+ **Member Engagement:** Use problem-solving skills to find alternative contact information for members who are unreachable by care management. Employ motivational interviewing techniques to maximize member engagement and promote lifestyle changes for optimal health.
+ **Monitoring and Documentation:** Adhere to case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies.
**Essential Competencies and Functions**
+ Meet performance and productivity metrics, including call volume, successful member engagement, and compliance with state/federal regulatory requirements.
+ Conduct oneself with integrity, professionalism, and self-direction.
+ Demonstrate a willingness to learn about care management within Medicare and Medicaid managed care.
+ Familiarity with community resources and services.
+ Navigate various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
+ Maintain strong collaborative and professional relationships with members and colleagues.
+ Communicate effectively, both verbally and in writing.
+ Exhibit excellent customer service and engagement skills.
**Required Qualifications**
+ 2+ years in behavioral health, social services, or a related field relevant to the program focus
+ Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and capable of utilizing these tools effectively in the CM Coordinator role
+ Access to a private, dedicated workspace to fulfill job requirements effectively.
**Preferred Qualifications**
+ Case management and discharge planning experience
+ Managed care experience
**Education**
+ High School Diploma with equivalent experience (REQUIRED)
+ Associate's or Bachelor's Degree or non-licensed master's level clinician in behavioral health or human services (psychology, social work, marriage and family therapy, counseling) or equivalent experience (PREFERRED)
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$21.10 - $44.99
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit anticipate the application window for this opening will close on: 08/15/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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Director of Case Management

30309 Midtown Atlanta, Georgia Select Medical

Posted today

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Job Description

**Overview**
**Emory Rehabilitation Hospital**
***In partnership with Select Medical***
Atlanta, GA
**Director of Case Management**
**Full-time / Salaried**
**Why Join Us:**
+ **Start Strong** : Extensive and thorough orientation program to ensure a smooth transition into our setting.
+ **Invest in Your Future** : Tuition reimbursement, and continuing education opportunities.
+ **Your Health Matters:** Comprehensive insurance coverage, health, dental vision, life insurance. Generous PTO and 401(K) with company match.
+ **Your Impact Matters:** Join a team of over 44,000 nationwide committed to providing exceptional care.
**Responsibilities**
**Position Summary**
The Director of Case Manager is responsible for the coordination of health care decisions by using a systematic approach to assure treatment plans that improve quality and outcomes, coordination of care across the continuum; promotion of cost-effective care within the allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and appropriate discharge plans. The primary job functions in Case Management include: Clinical Interventions/Discharge and Care Planning Management; Fiscal Management; and Payer/Referral Management.
**Qualifications**
**Minimum Qualifications**
+ Current Licensure per state guidelines in clinical or related discipline OR a Bachelor's or Master's in health or human services discipline.
+ Working knowledge of the health care insurance industry and government reimbursement.
+ Minimum two (2) years of experience with demonstrated health and human services leadership.
**Preferred Experience**
+ Minimum of three (3) years of experience in case management preferred.
+ Case Management Certification preferred.
**Additional Data**
**Overview of Select Medical Inpatient Rehabilitation Hospitals**
Select Medical's Inpatient Rehabilitation Hospitals provide advanced treatment and comprehensive care to best address the medical, physical, emotional and vocational challenges for individuals with:
+ Brain Injury
+ Spinal Cord Injury
+ Stroke
+ Amputation
+ Neurological Disorders
+ Orthopedic Conditions
+ Multiple Traumas
_Equal Opportunity Employer, including Disabled/Veterans_
Apply for this job ( this job
**Job ID** _334789_
**Experience (Years)** _3_
**Category** _Case Management - Director of Case Management_
**Street Address** _1441 Clifton Rd NE_
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Case Management and Intake Specialist

30383 Atlanta, Georgia Georgia Tech

Posted 1 day ago

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Job Description

Apply for Job Job ID 287517 Location Atlanta, Georgia Full/Part Time Full-Time Regular/Temporary Regular Add to Favorite Jobs Email this Job Job Summary

The Case Management and Intake Specialist is responsible for responding to reports of discrimination, harassment, and misconduct. This role involves coordinating intake interviews, documenting case details, coordinating next steps, and ensuring timely follow-up in accordance with the institute's policies and procedures. The Specialist provides clear guidance to those involved in reported issues and assists with case tracking and data reporting to ensure compliance and support ongoing improvement efforts.

Responsibilities

Job Duty 1 -
Coordinate formal intake interviews with individuals reporting prohibited conduct to gather detailed information, document allegations, and explain relevant policies and procedures.

Job Duty 2 -
Assess incoming reports to determine appropriate next steps, including referrals, supportive measures, or informal resolution processes.

Job Duty 3 -
Coordinate case-related processes, including maintaining accurate and confidential records, entering and updating case information in the case management system, and ensuring compliance with institutional policies and records retention schedules.

Job Duty 4 -
Prepare case summaries, correspondence, and reports for leadership, documenting interview outcomes and tracking case progress to ensure timely and consistent handling.

Job Duty 5 -
Coordinate supportive measures to address safety, academic, and workplace concerns, while supporting informal resolution efforts in consultation with unit leadership.

Job Duty 6 -
Coordinate adjudication process logistics for misconduct cases, ensuring fairness and adherence to institutional policies.

Job Duty 7 -
Track and analyze case data and trends to identify systemic issues, support compliance efforts, and inform institutional leadership.

Job Duty 8 -
Collaborate with internal stakeholders to ensure coordinated responses, and assist in transitioning cases to investigators or leadership as appropriate.

Job Duty 9 -
Coordinate training for educational initiatives and outreach efforts to enhance policy awareness and promote prevention across the campus community.

Job Duty 10 -
Perform other job-related duties as assigned.

Required Qualifications

Educational Requirements
Associate's Degree in a related discipline or equivalent combination of education and experience.

Required Experience
Two or more years of relevant experience.

Preferred Qualifications

Preferred Educational Qualifications
Bachelor's Degree in a related discipline or equivalent.

Proposed Salary

The salary range for this position is $55,029 - 74,841 annually.

Knowledge, Skills, & Abilities

ABILITIES
o The job requires occasional travel up to 10%
o Ability to handle sensitive and confidential matters
o Ability to navigate difficult situations with grace and empathy

KNOWLEDGE
o Demonstrated experience with trauma-informed approaches
o Demonstrated experience with software applications (i.e., Microsoft Office, Maxient, Banner, etc.)

SKILLS
o Excellent judgment skills
o Strong oral and written communication skills
o Advanced skills in general office administration include document processing and management,
records management, event management, problem solving, and office organization

USG Core Values

The University System of Georgia is comprised of our 26 institutions of higher education and learning as well as the System Office. Our USG Statement of Core Values are Integrity, Excellence, Accountability, and Respect. These values serve as the foundation for all that we do as an organization, and each USG community member is responsible for demonstrating and upholding these standards. More details on the USG Statement of Core Values and Code of Conduct are available in USG Board Policy 8.2.18.1.2 and can be found on-line at

Additionally, USG supports Freedom of Expression as stated in Board Policy 6.5 Freedom of Expression and Academic Freedom found on-line at

Equal Employment Opportunity

The Georgia Institute of Technology (Georgia Tech) is an Equal Employment Opportunity Employer. The University is committed to maintaining a fair and respectful environment for all. To that end, and in accordance with federal and state law, Board of Regents policy, and University policy, Georgia Tech provides equal opportunity to all faculty, staff, students, and all other members of the Georgia Tech community, including applicants for admission and/or employment, contractors, volunteers, and participants in institutional programs, activities, or services. Georgia Tech complies with all applicable laws and regulations governing equal opportunity in the workplace and in educational activities.

Georgia Tech prohibits discrimination, including discriminatory harassment, on the basis of race, ethnicity, ancestry, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, national origin, age, disability, genetics, or veteran status in its programs, activities, employment, and admissions. This prohibition applies to faculty, staff, students, and all other members of the Georgia Tech community, including affiliates, invitees, and guests. Further, Georgia Tech prohibits citizenship status, immigration status, and national origin discrimination in hiring, firing, and recruitment, except where such restrictions are required in order to comply with law, regulation, executive order, or Attorney General directive, or where they are required by Federal, State, or local government contract.

More information on these policies can be found here: Board of Regents Policy Manual | University System of Georgia (usg.edu).

Other Information

This is not a supervisory position.
This position does not have any financial responsibilities.
This position will not be required to drive.
This role is considered a position of trust.
This position does not require a purchasing card (P-Card).
This position will not travel
This position does not require security clearance.

Background Check

Successful candidate must be able to pass a position of trust background check. Please visit

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Manager, Clinical Care Case Management - Remote

30383 Atlanta, Georgia Guidehealth

Posted today

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Company DescriptionWHO IS GUIDEHEALTH? Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. Job DescriptionThe Manager, Clinical Care is primarily responsible for the day-to-day operations of an integrated multi-disciplinary clinical and clinical support structure that will effectively monitor, support, and lead Value Based clinical initiatives. This includes but is not limited to case management, transitions of care, care coordination and continuity, provider/staff education on ACO/MA Plan clinical programs, and helping to build and maintain a network of community support. This individual must exhibit strong leadership, management, and interpersonal skills, as well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the organization. WHAT YOU'LL BE DOING Effectively managing day to day Health Plan Clinical Programs to enhance clinical efficiencies Identifying opportunities for increased outpatient vs. inpatient utilization Utilizing data provided to help in managing population health needs and implement population programs for Health Plan beneficiaries Executing case management for patients identified at highest risk for adverse event or exacerbation, having the ability to impact, with the goal of decreasing unnecessary emergency department visits/hospitalizations Overseeing an extended patient care team as assigned including but not limited to: Social Workers, Emergency Department Liaisons, Behavioral Health Liaisons, and Home Health Liaisons. Overseeing smooth Transitional Care Management for all patients discharged from in patient facility (hospital, skilled nursing/rehab, behavioral health) ensuring: Primary Care Provider visit, DME and Home Health Services, Specialist appointments, and community resources/social services are provided as indicated. Ensuring Quality Measures are reviewed and addressed when applicable/appropriate Implementing and directing Health Plan Health Education Activities for beneficiaries, providers, and staff Participating in Care Coordination and Quality Committees, Primary Care Provider Meetings, and other meetings as required Monitoring corporate initiatives and strategies to achieve utilization of business and financial goals Managing the successful integration of ACO Programs into current operations to meet the goals of all stakeholders Maintaining collaborative relationships with business partners both within the company and the community Managing and execute organizational opportunities and implement changes that are in alignment with corporate financial goals and strategic endeavors. Managing departmental expectations: staff hiring, orientation, auditing, and reviews; time management; motivation; and performance improvement Prioritizing of data, tasks, and requirements: Project management with expertise in departmental tasks and processes Representing for health plan audits with development of actions plans for individual clients as needed to ensure compliance and incentive payouts Overseeing all projects, productivity, daily tasks and PHM activities in an organized and efficient manner Ensuring access to EMR systems for department staff Monitoring staff maintenance of HIPPA regulations Communicating with health plan contacts, customer Administrators and Client Business Managers to ensure resolution of any concerns. Identifying and disseminating of Health Plan announcements applicable to Case Management QualificationsWHAT YOU'LL NEED TO HAVE RN/BSN required 5 years of management experience 4 years clinical nursing experience At least 4 years of extensive experience in chronic care case management in outpatient setting Certification in case management preferred Must be able to work remotely and obtain state licensure in Illinois, Georgia, Pennsylvania, and Texas Must feel comfortable and confident leading a team of certified but unlicensed personnel and Registered Nurse case managers Ability to read, analyze, and interpret the most complex documents. Ability to respond effectively to the most sensitive inquiries or complaints. Additional InformationThe salary range for this position is $110,000ALIVE with Purpose: How We Thrive at Guidehealth At Guidehealth, our values come to life in everything we do. We are Driven by Accountability - grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike. Always Growing, Always Learning - staying curious and continuously improving inspires us to shape a better future for healthcare. With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve. At Guidehealth, Every Voice Matters - we believe our collective strength is rooted in the unique perspectives of each team member. And through Empathy in Action, we build stronger connections with those who count on us. This is what it means to be ALIVE with purpose. This is how we thrive - together - at Guidehealth. BENEFITS:All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals.Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.COMPENSATION:The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT Diversity, inclusion, and belonging are at the core of Guidehealth's values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment. OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATAThis position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth's custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager. REMOTE WORK TECHNICAL REQUIREMENTSGuidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The recommended internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.Videos To Watch

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RN - Case Management in Marietta, Georgia - $2,420/week

30064 Marietta, Georgia VETTED

Posted 4 days ago

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Vetted is seeking a RN - Case Management for a travel job in Marietta, Georgia. The job was posted 23 days ago. The assignment starts on ASAP and is 13 weeks long with 8 hour shifts 5 days a week. You must live 60 miles away from the facility in order to get the travel rate. The contract pays $2,420 per week gross, with $,694 in wages and 726 in stipend. You'll need 2 years of experience, BLS and national and state certification and/or as required. Benefits include 1. Quick Payments Weekly pay through direct deposit 2. Health Generous medical and dental plans 3. Housing Stipend and per diem available 4. 401K Matching Sliding scale matched up to 4% Additional benefits include: - Licensure reimbursement - Best in the industry medical, dental, and vision - Weekly pay through direct deposit - Generous referral bonus program - 24/7 support - 401k with employer match - Guaranteed hours - Assistance with travel and planning - Employee discount program - Competitive bonuses

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Social Work Case Manager

30309 Midtown Atlanta, Georgia Elevance Health

Posted today

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Job Description

**Social Work Case Manager**
**Location:** **Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.**
" _Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._ "
**Shift:** **Monday - Friday; 8:00am - 4:30pm ET with occasional evening availability depending on time zone.**
The **Social Work Case Manager** is responsible for ensuring effective psychosocial intervention, positively impacting a patient's ability to manage his/her chronic illness.
**How you will make an impact:**
+ Utilizes available community, government, and/or client resources needed to address participant's limitations or support interventions in the management of the participant's chronic condition.
+ Manages behavioral and psychosocial needs that result in improved clinical and financial outcomes and delivers social work interventions.
+ Assists members to effectively utilize available resources to meet their personal health needs and help them develop their own capabilities.
+ Evaluates members' ability to independently manage self and locate alternative resources when limitations are identified via a Social Work Psychosocial evaluation.
+ Provides guidance to members seeking alternative solutions to specific social, cultural, or financial problems that impact their ability to manage their healthcare needs.
+ Evaluates members' strengths related to health self-management, develops strategies to support healthcare needs and implements plans in support of case decisions.
+ Facilitates and coordinates behavioral health resources as individual member needs are identified.
**Minimum requirements:**
+ Requires MS (at a minimum) in Social Work and minimum of 3 years of experience in case management in a health care environment; or any combination of education and experience, which would provide an equivalent background.
+ Current unrestricted LMSW or LCSW (or equivalent) license in applicable state(s) required.
**Preferred skills, capabilities, and experiences:**
+ Bilingual (Spanish) or multi-language skills preferred.
For candidates working in person or virtually in the below locations, the salary* range for this specific position is $65,352 to $98,028.
Locations: New York
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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Social Work Care Manager / PRN

30309 Midtown Atlanta, Georgia Emory Healthcare/Emory University

Posted today

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**Overview**
**Be inspired. Be rewarded. Belong. At Emory Healthcare.**
At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:
+ Comprehensive health benefits that start day 1
+ Student Loan Repayment Assistance & Reimbursement Programs
+ Family-focused benefits
+ Wellness incentives
+ Ongoing mentorship, development, and leadership programs.and more!
**Description**
The Social Work Care Manager (PRN) is responsible for patient care coordination from admission through discharge; ensuring smooth transitions of care as the patient is discharged from the hospital setting, ensuring and facilitating high quality clinical and cost outcomes, procuring and securing post-acute services, coordinating and advocating for patients and families with both internal and external stakeholders, and identifying and addressing potential barriers to care coordination/discharge planning in an effort to foster efficient care delivery and maximize reimbursement.
+ The SW CM (PRN) will begin the process of care coordination at the time of the patients admission by completing a thorough admission assessment and/or psychosocial assessment which will allow for a timely and accurate capture of information as well as foster the ability to begin working towards a discharge plan.
+ The Registry SW CM (PRN) is an integral part of the interdisciplinary care team who is required to attend rounds, care conferences, and/or care team meetings.
+ The Registry SW CM (PRN) will act as a representative of both the hospital care team and the patient/family in an effort to balance patient/family choice and projected care coordination needs with the ability to execute such services. The SW CM (PRN) will work with the hospital care team and the patient/family in order to plan and implement the best possible plan for the patient while taking various factors, limitations, and patient/family preference into consideration.
+ The SW CM (PRN) will identify post-acute services and will complete referrals to appropriate post-acute care providers in a timely manner, coordinating directly with the patient/family as well as the care team. Through continuous assessment and review, the SW CM (PRN) will apply critical thinking to ensure alignment and appropriateness of post acute services as the patient clinically progresses throughout their stay.
+ Ultimately, the SW CM (PRN) is responsible for ensuring the discharge plan is aligned to be executed with the patients medically cleared for discharge date as well as the projected length of stay as provided by the payor.
+ The SW CM (PRN)identifies and participates in the development of strategies to reduce unnecessary length of stay and/or resource consumption. The SW CM (PRN) escalates cases, as appropriate, to management, Physician Advisor, Complex Care team and/or Ethics committee. It is the role of the SW CM (PRN) to educate patients/families as well as the care team as it relates to post acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices and available resources.
+ The SW CM (PRN) provides supportive and therapeutic communication for patients, families and loved ones who are experiencing anxiety or stress due to illness, injury or physical limitations.
+ The SW CM responds to suspected violent, assault, abuse and/or neglect cases in accordance with social work professional ethics.
+ The SW CM (PRN) must communicate confidently, effectively, and therapeutically while being assertive and conveying an impression which reflects favorably upon the organization. In collaboration with Utilization Review, the SW CM (PRN) will initiate and facilitate discussions with the payors to act as an advocate on behalf of the patient and hospital in an effort to reduce non-covered, non-authorized, or denied services.
+ The SW CM (PRN) serves as a resource to the Physician, Interdisciplinary Care Team, and patient for the interpretation of external regulations and organizational policies and procedures as it pertains to Discharge Planning and Care Coordination.
+ The SW CM (PRN)will ensure compliance with all regulatory requirements as it relates to Government and Commercial Payors. The SW CM (PRN) will ensure compliance with all third party payers and federal and state regulatory agencies. The SW CM (PRN) will ensure proper use of Case Management Systems and workflows.MINIMUM QUALIFICATIONS:
+ Must have a Masters in Social Work from an accredited Institution.
+ 1 year recent healthcare experience preferred, experience in Acute Care setting preferred.
+ Must have working knowledge of software/Eemr applications. Must meet all quality and productivity expectations and successfully complete yearly competencies.
+ Must be able to work 4 shifts/mo.
**Additional Details**
Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at . Please note that one week's advance notice is preferred.
**Connect With Us!**
Connect with us for general consideration!
**Division** _Emory Univ Hospital_
**Campus Location** _Atlanta, GA, 30322_
**Campus Location** _US-GA-Atlanta_
**Department** _EUH Social Services_
**Job Type** _Regular Full-Time_
**Job Number** _148094_
**Job Category** _Hidden (17365)_
**Schedule** _8a-4:30p_
**Standard Hours** _4 Hours_
**Hourly Minimum** _USD $0.00/Hr._
**Hourly Midpoint** _USD $0.00/Hr._
Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.
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Social Work Care Manager / PRN

30309 Midtown Atlanta, Georgia Emory Healthcare/Emory University

Posted today

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Job Description

**Overview**
**Be inspired. Be rewarded. Belong. At Emory Healthcare.**
At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:
+ Comprehensive health benefits that start day 1
+ Student Loan Repayment Assistance & Reimbursement Programs
+ Family-focused benefits
+ Wellness incentives
+ Ongoing mentorship, development, and leadership programs.and more!
**Description**
The **Care Manager** is responsible for patient care coordination from admission through discharge; ensuring smooth transitions of care as the patient is discharged from the hospital setting, ensuring and facilitating high quality clinical and cost outcomes, procuring and securing post-acute services, coordinating and advocating for patients and families with both internal and external stakeholders, and identifying and addressing potential barriers to care coordination/discharge planning in an effort to foster efficient care delivery and maximize reimbursement.
The CM will begin the process of care coordination at the time of the patient's admission by completing a thorough admission assessment and/or psychosocial assessment which will allow for a timely and accurate capture of information as well as foster the ability to begin working towards a discharge plan.
The CM is an integral part of the interdisciplinary care team who is required to attend rounds, care conferences, and/or care team meetings. The CM will act as a representative of both the hospital care team and the patient/family in an effort to balance patient/family choice and projected care coordination needs with the ability to execute such services. The CM will work with the hospital care team and the patient/family in order to plan and implement the best possible plan for the patient while taking various factors, limitations, and patient/family preference into consideration. The CM will identify and recommend post-acute services and will complete referrals to appropriate post-acute care providers in a timely manner, coordinating directly with the patient/family as well as the care team. Through continuous assessment and review, the CM will apply critical thinking to ensure alignment and appropriateness of post -acute services as the patient clinically progresses throughout their stay. Ultimately, the CM is responsible for ensuring the discharge plan is aligned to be executed with the patient's medically cleared for discharge date as well as the projected length of stay as provided by the payor. The CM identifies and participates in the development of strategies to reduce unnecessary length of stay and/or resource consumption. The CM escalates cases, as appropriate, to management, Physician Advisor, Complex Care team and/or Ethics committee.
It is the role of the CM to educate patients/families as well as the care team as it relates to post acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices and available resources. The CM provides supportive and therapeutic communication for patients, families and loved ones who are experiencing anxiety or stress due to illness, injury or physical limitations.
The CM must communicate confidently, effectively, and therapeutically while being assertive and conveying an impression which reflects favorably upon the organization.
The CM will initiate and facilitate discussions with the payors in order to act as an advocate on behalf of the patient and hospital in an effort to reduce non-covered, non-authorized, or denied services. The CM will issue and administer notices of non-coverage and potential liability to patients in accordance with predetermined regulations, policies, and procedures. The CM serves as a resource to the Physician, Interdisciplinary Care Team, and patient for the interpretation of external regulations and organizational policies and procedures as it pertains to Discharge Planning and Care Coordination. The CM will ensure compliance with all regulatory requirements as it relates to Government and Commercial Payors. The CM will ensure compliance with all third party payers and federal and state regulatory agencies. The CM will ensure proper use of Case Management Systems and workflows.
**MINIMUM QUALIFICATIONS:**
+ Must have a Masters in Social Work from an accredited Institution.
+ 1 year recent healthcare experience preferred, experience in Acute Care setting preferred.
+ Must have working knowledge of software/Eemr applications. Must meet all quality and productivity expectations and successfully complete yearly competencies. Must be able to work 4 shifts/mo.
**JOIN OUR TEAM TODAY!** Emory Healthcare (EHC), part of Emory University (EUV), is the most comprehensive academic health system in Georgia and the first and only in Georgia with a Magnet® designated ambulatory practice. We are made up of 11 hospitals-4 Magnet® designated, the Emory Clinic, and more than 425 provider locations. The Emory Healthcare Network,establishedin 2011, is the largest clinically integrated network in Georgia, with more than 3,450 physicians concentrating in 70 different subspecialties.
**Additional Details**
Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at . Please note that one week's advance notice is preferred.
**Connect With Us!**
Connect with us for general consideration!
**Division** _Emory Univ Hospital_
**Campus Location** _Atlanta, GA, 30322_
**Campus Location** _US-GA-Atlanta_
**Department** _EUH Social Services_
**Job Type** _PRN / Registry_
**Job Number** _147102_
**Job Category** _Hidden (17365)_
**Schedule** _8a-4:30p_
**Standard Hours** _4 Hours_
**Hourly Minimum** _USD $0.00/Hr._
**Hourly Midpoint** _USD $0.00/Hr._
Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.
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Social Work Care Manager / Preceptor

30032 Decatur, Georgia Emory Healthcare/Emory University

Posted today

Job Viewed

Tap Again To Close

Job Description

**Overview**
**Be inspired. Be rewarded. Belong. At Emory Healthcare.**
At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be.
We provide:
+ Comprehensive health benefits that start day 1
+ Student Loan Repayment Assistance & Reimbursement Programs
+ Family-focused benefits
+ Wellness incentives
+ Ongoing mentorship, _development,_ and leadership programs
+ And more
**Credentials required for this role: RN or LMSW/LCSW**
**Description**
We are seeking a capable **Care Manager, Preceptor (RN or LMSW/LCSW)** who has acquired broad experience in caring for patients and has developed a sound understanding about the care of a particular patient population.
+ The Care Manager, Preceptor will be responsible for training, mentoring, and coaching for the Care Management Department.
+ The CM Preceptor must be an expert in the care management and discharge planning functions and able to cover any role at any given time as well as manage an active caseload for care management and discharge planning.
+ The CM Preceptor will be regarded as a clinical expert, leader, and role model within the Care Management Department as it relates to the understanding and application care management and discharge planning in its entirety.
+ The CM Preceptor will demonstrate foresight regarding the impact of both the clinical and administrative roles within the discharge planning process based on critical thinking, intuition, and experience.
+ The CM Preceptor will be responsible for new hire onboarding, training, and competency completion.
+ In addition, the CM Preceptor will be responsible for ongoing departmental education to ensure Care Management is a high performing department.
+ The CM Preceptor will coordinate with Care Management leaders to ensure policies, procedures, and standard work are consistently updated and maintained and employees are trained appropriately and timely in order to ensure consistent expectations and maintain quality throughout the department.
+ The CM Preceptor will play a vital role in partnering with Care Management medical directors and clinical providers to ensure the Physician/provider role as well as the CM roles are continually optimized.
**MINIMUM QUALIFICATIONS:**
+ Must have a Masters in Social Work or Bachelors in Nursing from an accredited Institution.
+ 3-5 years recent healthcare experience required, experience in Acute Care setting required.
+ LMSW or LCSW license in the state of Georgia required for Social Workers.
+ Must have working knowledge of software/Eemr applications. ACM, CCM preferred.
JOIN OUR TEAM TODAY! Emory Healthcare (EHC), part of Emory University (EUV), is the most comprehensive academic health system in Georgia and the first and only in Georgia with a Magnet® designated ambulatory practice. We are made up of 11 hospitals-4 Magnet® designated, the Emory Clinic, and more than 425 provider locations. The Emory Healthcare Network, established in 2011, is the largest clinically integrated network in Georgia, with more than 3,450 physicians concentrating in 70 different subspecialties.
**Additional Details**
Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at . Please note that one week's advance notice is preferred.
**Connect With Us!**
Connect with us for general consideration!
**Division** _Emory Decatur Hospital_
**Campus Location** _Decatur, GA, 30033_
**Campus Location** _US-GA-Decatur_
**Department** _DEC-Care Management_
**Job Type** _Regular Full-Time_
**Job Number** _143970_
**Job Category** _Nursing_
**Schedule** _7:30a-4p_
**Standard Hours** _40 Hours_
**Hourly Minimum** _USD $48.62/Hr._
**Hourly Midpoint** _USD $56.36/Hr._
Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.
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