- Sutter Health (Goleta, CA)
- …AND KNOWLEDGE:** + A broad knowledge base of health care delivery and case management within a managed care environment. + Comprehensive knowledge of ... + RN-Registered Nurse of California + CCM - Certified Case Manager (certification may be required by...Medicare and Medicaid Services (GR) Grouper (CMS), Department of Managed Health Care , National Committee for Quality… more
- City of New York (New York, NY)
- …(MCP), interfaces with managed care delivery systems comprised of Managed Care Organizations (MCOs) and case management providers through which ... Assistance Program (MAP), is recruiting for one (1) Administrative Manager NM-III, to function as the Executive Director, of...the Executive Director, of the Office of Mail Renewal, Managed Care Program (MCP), and Third-Party Health… more
- UNC Health Care (Raleigh, NC)
- …with external care teams + Provide warm handoffs to managed care partners or community navigators **4. Complex Case Rounds (Weekly)** + Facilitate ... support to a network of 6 owned and 10 managed hospitals.** **This position is a 40 hour per...case management, utilization review and discharge planning. The Care Manager must be highly organized professional… more
- CommuniCare Health Services Corporate (Charleston, WV)
- …to support our Central Billing Office team. PURPOSE/BELIEF STATEMENT The position of Managed Care Claims Validator / Biller is responsible for accurate and ... timely filing of all managed care claims on their assigned caseload...cash collections team, CBO cash posting team, Business Office Manager , Regional Director of Finance, MDS, Case … more
- Henry Ford Health System (Troy, MI)
- …EDUCATION/EXPERIENCE REQUIRED: + Bachelor's degree in Finance, Accounting, Business Administration, Managed Care Contracting, Reimbursement, or related field. + ... GENERAL SUMMARY: Under minimal supervision of the Manager , independently leads financial and data analysis to...to seven (5-7) years of experience in healthcare finance, managed care contracting, or reimbursement in a… more
- Guthrie (Troy, PA)
- … Manager monitors clinical approaches and make recommendations for alternate levels of care . The Acute Case Manager also performs Utilization Management ... with the patient and members of the interdisciplinary health care team. The Acute Case Manager...positive and professional relationship with payers that supports continued managed care contracts. c) Articulates the primary… more
- ChenMed (North Miami Beach, FL)
- … Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (CMCN) desired. We're ChenMed and we're transforming healthcare for ... facilities, as well as, their home environments. The Nurse Case Manager 1 (RN) role also involves... givers, primary care physicians, specialists, other care providers, social workers, other case managers… more
- Highmark Health (Dover, DE)
- …human services field. **EXPERIENCE** + 5 years of a clinical setting + 3 years in a case management/ managed care role + 3 years in a management or leadership ... :** **JOB SUMMARY** This job supervises a team of Case Manager Supervisors who are charged with...professional development skills + Medicare and Medicaid experience + Managed care experience + Experience in geriatric… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …other projects, work, and activities as assigned by the Pharmacy Director Qualifications: + Managed Care experience preferred, but not required + Part D Coverage ... and coding to be submitted to the Pharmacy Benefit Manager , New Contract Year formulary evaluation, and rebate strategy...of, or currently enrolled in, residency program (PGY1) in managed care pharmacy, or pharmacy practice. +… more
- Arnot Health (Elmira, NY)
- …participates in quality improvement and evaluation processes related to the management of patient care . The Case Manager will review all patients for ... Job Description MAIN FUNCTION: The Case Manager coordinates, negotiates, procures services...of care meetings related to the appropriate case managed population. d. Manages the appropriate… more
- Molina Healthcare (Indianola, IA)
- …until they are discharged from your service. The ideal candidate will have experience as a Care Manager within a managed care organization (MCO) like ... **JOB DESCRIPTION** Opportunity for an experienced Care Manager to join the LTSS...Long Term Services & Supports. + 1-3 years in case management, disease management, managed care… more
- Banner Health (Tucson, AZ)
- …and resources that promote a healthy work-life balance. As the Registered Nurse RN Case Manager Care Coordination, you will have the opportunity to ... members of the health care team on case management and managed care ...require a minimum of one year Case Manager experience in an acute care hospital.… more
- Molina Healthcare (West Des Moines, IA)
- …related case management experience. **Required Experience** 3 or more years in case management, disease management, managed care or medical or behavioral ... and assigns cases appropriately regarding complexity of medical or psychosocial needs and case manager experience (RN, LSW, other allied fields). + Oversees the… more
- Banner Health (Sun City, AZ)
- …requirements. 6. Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts ... positions require a minimum of one year Case Manager experience in an acute care hospital. PREFERRED QUALIFICATIONS Certification for CCM (Certified Case … more
- Mount Sinai Health System (New York, NY)
- …a. Develops and maintains effective working relationships with interdisciplinary team and Case Managers within the managed care organizations. 7. ... **Job Description** **RN/ Case Manager MSH Case ...**Job Description** **RN/ Case Manager MSH Case Management FT Days**...population; b. Provides the clinical information requested by the managed care companies as part of the… more
- InGenesis (Columbia, SC)
- …Identify and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, etc.). * ... InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will review… more
- CVS Health (Columbus, OH)
- …And we do it all with heart, each and every day. **Position Summary** The Care Plan Reviewer (Clinical Case Manager BH) utilizes advanced clinical judgment ... . + Independent clinical license preferred: LPCC, IMFT, or LISW + Managed care /utilization review experience + Case management and discharge planning… more
- Bishop McCarthy Center (Vineland, NJ)
- Employee Heath/ Managed Care / Infection Control Registered Nurse has oversight over functions of the employee health program which include pre employment ... testing, work related injury follow-up, knowledge of infection control practices. Case Manager ressponsciblitlies include gathering information to submit to… more
- CVS Health (East Orange, NJ)
- …may include pediatric population and medically complex cases. The case manager is responsible for coordinating and collaborating care with the ... member/authorized representative, PCP, and any other care team participants. The case ... Case management and/or discharge planning experience + Managed Care experience + Medicaid and Medicare… more
- Highmark Health (Dover, DE)
- …+ One year in home clinical or case management experience + Certified Case Manager (CCM) + Licensed Bachelors Social Worker (LBSW) + Licensed Masters Social ... working with developmental disabilities population + Medicare and Medicaid experience + Managed care experience **SKILLS** + Working flexible hours to meet… more
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