- LA Care Health Plan (Los Angeles, CA)
- …California License. Licenses/Certifications Preferred Certified Case Manager (CCM) Accredited Case Manager (ACM) Certification Case Management Nurse - ... Care Management Specialist II Job Category: Clinical ...interactions and interventions with members, vendors, and providers. Maintains case information in the member's clinical records… more
- CVS Health (Phoenix, AZ)
- …health plan, and regulator. + Applies and interprets applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, ... ASD ( _Autism Spectrum Disorder_ ). This person utilizes clinical judgment and critical thinking skills to facilitate appropriate...of care to meet the member's goals. + Utilizes case management and quality management … more
- ERP International (Nellis AFB, NV)
- …professionals/departments to identify members needing additional education or clinical management of selected diseases. * Collaborates with case manager, ... specialties, ambulatory care nursing, prevention, health promotion, disease/condition management , case management , discharge planning, and clinical data… more
- Children's Mercy Kansas City (Kansas City, MO)
- … clinical outcomes and efficiency of inpatient stays. Continually strives to integrate case management and social work across the system. + Ensures ... for providing leadership, strategic planning, and oversight of daily operations of the case management department which includes utilization management , care… more
- Humana (Denver, CO)
- …prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning and/or home health or ... complex clinical scenarios, review of all submitted clinical records, prioritization of daily work , communication... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- Commonwealth of Pennsylvania (PA)
- … BEHAVIOR 1 - SUPERVISION Distributes and monitors work assignments of case aides and care management and assessment staff; monitors and approves ... of the Pennsylvania Report of Need to ensure proper case assignment, documentation, and compliance. Work Schedule...conferences, and staff meetings designed to develop performance and case management skills and familiarize staff with… more
- Mount Sinai Health System (Long Island City, NY)
- …and workload within each department. Directs, coaches, mentors and assesses staff in clinical case management service delivery. 2.Ensures departments achieve ... nursing or healthcare-related field **Experience Requirements** 5 years of Case Management and 6 years of clinical nurse experience. Previous supervisory… more
- Elevance Health (Miami, FL)
- …critical thinking skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate ... Nurse** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person...about plan benefits and physicians and may assist with case management . + Collaborates with leadership in… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …Information Management , or related field * Minimum 3 years of experience in clinical care, utilization review, case management , or clinical ... payer denials, coordinating peer-to-peer reviews, and working closely with physician advisors, case management , and revenue cycle teams. The UM Analyst helps… more
- Molina Healthcare (Florence, SC)
- …resident of South Carolina** **Job Description** **Job Summary** The Molina Population Health Management Case Manager uses clinical judgment, knowledge, and ... provided directly or referred / escalated. HM CM staff work to ensure that members progress toward desired outcomes...member case load for regular outreach and management . + Use motivational interviewing and Molina clinical… more