- AmeriHealth Caritas (Cullowhee, NC)
- **Role Overview** The Care Manager (RN/LCSW) assists members appropriate for care management and care coordination services in achieving their optimal ... level of health through self-management. The Care Manager (RN/LCSW) is responsible for engaging...to ensure the AMH Tier III/CIN delivers high quality care management services in accordance with Plan, NCQA… more
- AmeriHealth Caritas (Rock Hill, SC)
- **Role Overview:** The Care Manager (RN) assists members appropriate for care management and care coordination services in achieving their optimal level ... of health through self-management. The Care Manager (RN) is responsible for engaging...Medical Home Tier III/Clinically Integrated Network delivers high quality care management services in accordance with Plan, NCQA… more
- AmeriHealth Caritas (Rock Hill, SC)
- **Role Overview;** The Care Manager II is responsible for managing and coordinating care , services, and social determinants of health for Members with acute, ... issues, gaps in care and barriers to care . The Care Manager II...community resources and programs, and applicable regulatory, state, and NCQA requirements + May identify cases to be presented… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …Federal Employee Program (FEP) and National Committee for Quality Assurance ( NCQA ) accreditation standards, as appropriate to the member's case assignment. Uses ... program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and… more
- Sharp HealthCare (San Diego, CA)
- …and CMS. Develops and implements new programs under the direction of the manager of in-patient care management and the Director of Utilization Management. ... plans related to health plan audits and requirements of NCQA . Collaborates with the Quality, Compliance and Training Department...2 Years Medical Management experience, preferably in a managed care setting + California Registered Nurse (RN)… more
- LA Care Health Plan (Los Angeles, CA)
- … care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments. Experience providing care ... skills and judgement. Management of the caseload assigned by Manager includes: coordinating health care benefits, providing...Preferred Certified Case Manager (CCM) Accredited Case Manager (ACM) Certification Case Management Nurse -… more
- Apex Health Solutions (Houston, TX)
- …Using a defined process to identify patients/members at risk for poor outcomes, the Case Manager establishes care plans and goals, and coordinates care and ... well-being, improving adherence to health programs, and reducing health care costs. The Case Manager must be...Strong ability to demonstrate knowledge of ACO initiatives and care management processes Understanding of NCQA and… more
- Sharecare (Frankfort, KY)
- …Bachelor's degree preferred + 5+ years' experience in Care /Case Management + NCQA experience preferred + Certified Case Manager preferred + Prior management ... positively impact the greater team and aid in their personal development as a Care Manager . + Provide performance management for the team of Care Managers to… more
- Kelsey-Seybold Clinic (Houston, TX)
- …and nursing care for patients with complex care needs. The Care Manager - Nurse Practitioner assesses the physical and psycho-social condition ... obtaining comprehensive or problem-focused physical examinations and medical histories. The Care Manager orders, collects, interprets, and evaluates laboratory… more
- Somatus (Mclean, VA)
- Overview As the largest and leading value-based kidney care company, Somatus is empowering patients across the country living with chronic kidney disease to ... + Community engagement opportunities + And more! The **Sr.** **HEDIS Manager ** will be r _esponsible for providing operational/strategic support in planning,… more