13 Healthcare Providers jobs in Deatsville

**Company :**
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
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Req ID: J

**Overview**
**Advance Hospice Care. Lead Clinical Excellence. Inspire Compassionate Teams.**
We are seeking a dedicated Patient Care Manager to join our hospice team. Reporting directly to the Executive Director or Administrator, you will oversee patient care activities to ensure the delivery of high-quality, compliant hospice services. This leadership role involves managing clinical operations, coordinating care, and developing staff to uphold the highest standards of patient care and regulatory compliance.
**As a Hospice Patient Care Manager, You Will:**
+ O versee and direct patient care services to ensure the delivery of high-quality hospice care
+ M anage visit scheduling, including reassigned, missed, declined, or rescheduled visits-making decisions based on clinical judgment and priority
+ T riage incoming phone referrals and medical concerns in a timely, compassionate, and professional manner
+ L ead or facilitate Interdisciplinary Group (IDG) meetings, including presenting patient updates, reviewing charts, coordinating care plans, and documenting minutes
+ S erve as a mentor, trainer, and clinical support to associates, supporting development, performance, and compliance
+ E nsure all care delivery meets federal, state, and local regulatory standards, as well as company policies and procedures
+ S upport performance improvement initiatives, quality assessments, and operational efficiencies within your location
**About You**
**Qualifications - What You'll Bring:**
+ Current RN license in the state of employment
+ Graduate of an accredited nursing program
+ Minimum of 3 years of direct patient care experience, including 2 years in a hospice or home-based care setting
+ Demonstrated ability to apply hospice principles, industry standards, and regulatory compliance (Medicare, Medicaid, JCAHO, ACHC)
+ Knowledge and compassion for terminally ill patients and their families
+ Ability to lead a diverse care team while adapting to the emotional and clinical needs of patients from various backgrounds
+ Strong interpersonal, organizational, and leadership skills
+ Competency in clinical documentation and technology systems
**Preferred Qualifications (Not Required):**
+ Bachelor of Science in Nursing (BSN)
+ Previous leadership, team management, or supervisory experience in hospice or home health
+ Familiarity with EMR systems and telehealth platforms
+ Certification in Hospice and Palliative Nursing (CHPN)
**We Offer**
**Benefits for All Associates (Full-Time, Part-Time & Per Diem):**
+ Competitive Pay
+ 401(k) with Company Match
+ Career Advancement Opportunities
+ National & Local Recognition Programs
+ Teammate Assistance Fund
**Additional Full-Time Benefits:**
+ Medical, Dental, Vision Insurance
+ Mileage Reimbursement or Fleet Vehicle Program
+ Generous Paid Time Off + 7 Paid Holidays
+ Wellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care)
+ Education Support & Tuition Assistance (ASN to BSN, BSN to MSN)
+ Free Continuing Education Units (CEUs)
+ Company-paid Life & Long-Term Disability Insurance
+ Voluntary Benefits (Pet, Critical Illness, Accident, LTC)
**Ready to Join a Team That Cares?**
Apply today and help us lead the way in delivering hospice care that truly matters.
**Legalese**
+ This is a safety-sensitive position
+ Employee must meet minimum requirements to be eligible for benefits
+ Where applicable, employee must meet state specific requirements
+ We are proud to be an EEO employer
+ We maintain a drug-free workplace
Keywords: patient care manager RN, hospice RN supervisor, hospice leadership, registered nurse manager, hospice nurse jobs, nurse leader, hospice case management, home health manager, end-of-life care leadership
ReqID:
Category: Single Site Ops and Clinical Leadership
Position Type: Full-Time
Company: Gentiva Hospice

FT 4 - 10 hour shifts (nights/flex) M-F with leadership call rotation

Under the direction of the Director, the Patient Care Manager (PCM) is responsible on a 24-hour basis for the planning and comprehensive operations of a specific clinical unit or group of units ensuring compliance with hospital and nursing mission, goals, philosophy, policies and procedures. The Patient Care Manager utilizes the nursing process in the delivery of patient care and ensures quality care is provided through appropriate allocation of human resources, maintaining financial control of the unit, and serving as a liaison between administration and staff. The individual demonstrates personal and professional responsibility; participates in creating an atmosphere of mutual trust, acceptance, recognition and respect; and assumes responsibility for own professional development. This position serves as liaison to physicians, administration and hospital staff. rec:max

Unrestricted AL or Multi State RN license and BLS required, BSN preferred. 3 years of L&D experience including 1 year of charge nurse / leadership experience, preferred.