- US Tech Solutions (Columbia, SC)
- …Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, etc.). ... which may include but is not limited to ERISA, NCQA , URAC, DOI (State), and DOL (Federal). + Provides...determine medical necessity criteria and contract benefits. Collaborates with Care Management and other areas to ensure proper … more
- AmeriHealth Caritas (Charleston, SC)
- …Overview** Under the supervision of the Director Clinical Market Population Health, the Manager of Integrated Care Management is responsible for the daily ... operations of the Complex Care Management and Behavioral Health teams. Responsible for compliance...departmental goals and objectives.; Responsible for achievement of assigned NCQA standard compliance and compliance with all applicable State… more
- US Tech Solutions (Columbia, SC)
- …Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, etc.). ... critical thinking skills. + Experience in case management or care coordination and telephonic care experience is...bodies, which may include but isnot limited to ERISA, NCQA , URAC, DOI (State), and DOL (Federal). + Participates… more
- WellSense (Manchester, NH)
- …coaching, development and evaluation of employee performance. Positions reporting to the manager include, Nurse Care Clinicians, Social Workers, Community ... Manager of Care Management WellSense Health...federal and state regulations and applicable accreditation standards (eg NCQA ) + Works closely with all appropriate internal departments… more
- US Tech Solutions (Columbia, SC)
- …Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of Care Referrals, etc.). ... health coach, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support...which may include but is not limited to ERISA, NCQA , URAC, DOI (State), and DOL (Federal). + Participates… more
- Sharp HealthCare (San Diego, CA)
- …Time** Bachelor's Degree in Nursing; Bachelor's Degree; Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Professional in ... Healthcare Quality (CPHQ) - National Association for Healthcare Quality; Certified Case Manager (CCM) - Commission for Case Manager Certification **Hours** **:**… more
- WellSense (Manchester, NH)
- Clinical Care Manager WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, ... that works for our members, no matter their circumstances. **Job Summary** The Clinical Care Manager provides holistic medical care management services for… more
- AmeriHealth Caritas (Detroit, MI)
- …services. Discover more about us at www.amerihealthcaritas.com. **Role Overview:** The Care Manager II is responsible for managing and coordinating ... of healthcare leaders. At AmeriHealth Caritas, we're passionate about helping people get care , stay well, and build healthy communities. As one of the nation's… more
- Intermountain Health (Salem, OR)
- …while promoting self-management, quality, and cost-effective outcomes. **Essential Functions** + The nurse care manager works collaboratively with physicians ... and fully funded and self-funded Commercial Employer plans. The Care Manager works with Select Health members,...and progress according to applicable regulatory requirements such as NCQA , CMS and State EQRO standards. + Coordinates and… more
- AmeriHealth Caritas (Newark, DE)
- The Maternal Care Manager (Registered Nurse /Social Worker) assists maternity members who are appropriate for care management and care coordination ... in achieving their optimal level of health through self-management. The Maternal Care Manager /Coordinator (RN/SW) engages the member, caregivers, and providers… more