- CVS Health (Dover, DE)
- …Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate ... of Care: * Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and… more
- CVS Health (Dover, DE)
- …Interviewing and good technological skills + Valid unrestricted independent professional behavioral health clinical license to practice per state regulations ... standard business hours. No weekends and no holidays.** Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical… more
- Highmark Health (Dover, DE)
- …or other related clinical license **Preferred** + CCM - Certified Case Manager Certification **SKILLS** + Leadership, collaboration, and motivational skills ... :** **JOB SUMMARY** This job supervises a team of Case Manager Supervisors who are charged with...human services field. **EXPERIENCE** + 5 years of a clinical setting + 3 years in a case… more
- Highmark Health (Dover, DE)
- …year in home clinical or case management experience + Certified Case Manager (CCM) + Licensed Bachelors Social Worker (LBSW) + Licensed Masters Social ... referrals to special programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management. +...Worker (LMSW) + Licensed Clinical Social Worker (LCSW) + Experience working with HIV/AIDS… more
- Highmark Health (Dover, DE)
- …Nursing **EXPERIENCE** **Required** + 7 years of any combination of clinical , case management and/or disease/condition management experience, provider operations ... panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of...interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are… more
- Highmark Health (Dover, DE)
- …with Medicaid or Medicare populations **Preferred** + Experience working with Pediatric, Behavioral Health, and Physical Health. + Case Management and Discharge ... services. Advocates for the most appropriate care plan using sound clinical judgment; accurate planning, and collaboration with internal and/or external customers… more
- Sevita (Elkton, MD)
- …identify any discrepancies to accounting staff + Coordinate utilization with the Case Manager relative to program participant's incentive account + Organize ... as directed + Assist in internal communication to team members regarding case -specific issues + Attend required meetings, including clinical team meetings… more
- AmeriHealth Caritas (Newark, DE)
- …of the Supervisor of the Integrated Care Management Department, the Care Manager Senior is responsible for assisting the supervisor in the daily operations ... development, reviewing referrals for appropriateness, and assigning episodes as needed.; Practices case management within the scope of their licensure (based on the… more
- AmeriHealth Caritas (Dover, DE)
- …care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about ... us at www.amerihealthcaritas.com . **Role Overview** The Care Manager /Coordinator (RN/SW) assists members appropriate for care management and care coordination… more
- CenterWell (Dover, DE)
- …Intelligence Lead and support ad hoc reporting. * Develop basic modeling and business case analysis; work closely with Finance and Data teams * Coordinate with ACO ... that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time… more
- Highmark Health (Dover, DE)
- …Is responsible for or works with external resources to create and monitor inpatient case mix reports and the top 25 assigned DRGs/APCs in the facilities to identify ... related to special projects and providing coverage for coding manager (s). (10%) + Depending on location provides or arranges...processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and… more