- Optum (Aurora, CO)
- …on a global scale. Join us to start Caring. Connecting. Growing together. The Case Manager RN is responsible and accountable for coordination of patient services ... medical unit to drive timely discharges and plans of care CMS Compliance: All Medicare and Medicare Advantage patients are required a delivery notice… more
- Boston Scientific (Valencia, CA)
- …be supported in progressing - whatever your ambitions. About the role: The Patient Access Case Manager is responsible for managing the patient case through ... in administrative law judge hearings via phone, presenting on behalf of the Medicare Advantage patient. Submit prior authorization requests to health plan as… more
- CenCal Health (Santa Barbara, CA)
- …and the Medi-Cal and Medicare Dual Special Needs Programs (D-SNP) or Medicare Advantage programs is strongly preferred High proficiency with Microsoft Office ... & Experience Required: Experience working in a healthcare call center, preferably Medicare Advantage or specific D-SNP experience, human services, or public… more
- FC Compassus LLC (Marshfield, WI)
- Company: Compassus Position Summary The Inpatient Unit (IPU) Registered Nurse Case Manager is responsible for modeling the Compassus values of Compassion, ... company, among all departments, and all external stakeholders. The IPU Registered Nurse Case Manager functions as a member of the Interdisciplinary Team (IDT)… more
- GLOBALHEALTH HOLDINGS LLC (Oklahoma City, OK)
- …Type Full Time Job Shift Day Description WHO WE ARE: GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice ... Through interdepartmental communication, network communication, and member outreach the Case Manager remains aware of patient needs and changes in condition,… more
- US Tech Solutions (Canton, MA)
- …/ lines of business; such as state specific Medicaid and Senior Products ( Medicare Advantage and SCO). The Clinical Reviewer ensures consistent and timely ... UM team and works under the general direction of the Precertification Team Manager or department Manager . The Clinical Reviewer is expected to demonstrate… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare Advantage Plan visibility in the community by monitoring multiple ... performing all required tasks assigned by the Sales Field Manager . Incumbent will be responsible for educating and enrolling...issued by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. Under limited ... within 60 days of date of hire. + Certified Case Manager (CCM) or other industry recognized...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
- TEKsystems (Morrisville, NC)
- …specific to program/client requirements. Skills + Insurance verification, Prior authorization, Case management, benefit investigation, medicare part d, benefit ... delivery, pharmaceutical insurance Top Skills Details + Insurance verification,Prior authorization, Case management,benefit investigation, medicare part d,benefit delivery,pharmaceutical insurance… more
- TEKsystems (Morrisville, NC)
- Now Hiring: Reimbursement Case Manager | Entry-Level | Remote (On-site Training in Morrisville, NC) Are you ready to launch your career in healthcare support and ... patient advocacy? We're looking for a Reimbursement Case Manager who's passionate about helping patients...Insurance verification & benefit investigation + Prior authorization & case management + Medicare Part D knowledge… more
- Henry Ford Health System (Wyandotte, MI)
- …for the past 34 consecutive years. PART TIME 20 HOUR DAYS GENERAL SUMMARY: The Case Manager is a member of the hospital or specialty-based patient-centered care ... and family's health care needs. The goals of the case manager are to promote patient safety,...preventive service guidelines, clinical practice guidelines, behavior change theory, Medicare and Medicaid regulations and case management… more
- TEKsystems (Morrisville, NC)
- Reimbursement Case Manager Location: Morrisville, North Carolina (Hybrid work setup) | Full-Time Are you passionate about helping patients navigate the complex ... fast-paced, service-oriented environment? Join our team as a Reimbursement Case Manager and make a real difference...Insurance verification & benefit investigation + Prior authorization & case management + Knowledge of Medicare Part… more
- University of Miami (Medley, FL)
- …. The UHealth System at the University of Miami has an exciting opportunity for a Case Manager RN in the Population Health Department. SUMMARY The Case ... duties as directed and under the supervision of RN Manager Case Management. + Collaborates with Primary...on a team for data collection, health outcomes reporting, Medicare Advantage HEDIS clinical audits, and programmatic… more
- TEKsystems (Morrisville, NC)
- Job Posting: Reimbursement Case Manager Employment Type: Full-Time Experience Level: Entry Level Industry: Healthcare | Pharmaceutical Access & Benefits ... Skills + Insurance verification + Prior authorization handling + Case management and documentation + Medicare Part...We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …Certification required. Required Skills: A working knowledge and understanding of Medicare / Medicare Advantage , Medicaid, Commercial, and other third-party ... and medical background to include, high-risk screenings related to case management and proposed interventions/outcomes. + Performs proactive discharge planning,… more
- Highmark Health (Pittsburgh, PA)
- …with unique processing arrangements including Federal Employee Program (FEP) and Medicare Advantage . **ESSENTIAL RESPONSIBILITIES** + Coordinates the clinical ... **Job Description :** Date Posted: 20250509 Location: Allegheny General Hospital Department: Case Management, Inpatient Status: Full Time Shift: 80 hours every two… more
- Trinity Health (Westerville, OH)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** RN Case Manager , Full-time **Why Mount Carmel?** With five hospitals ... (https://www.mcmg.mountcarmelhealth.com/) , a college of nursing (https://www.mccn.edu) , a Medicare Advantage plan (https://www.medigold.com) , and extensive… more
- Rush University Medical Center (Chicago, IL)
- …third party payers including but not limited to Managed Care Commercial payers, Medicare Advantage payers and Medicaid payers and negotiating managed care ... Offers may vary depending on the circumstances of each case . **Summary:** Rush Health is a clinically integrated network...highly desirable. + Experience with governmental programs related to Medicare , Medicaid and Medicare Advantage … more
- Datavant (Providence, RI)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage , HHS (ACA), and other markets. + Provide guidance and make ... vision for healthcare. As a Sr. Client Coding Project Manager , you will plan, forecast, and manage client-facing coding...+ Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial… more
- Molina Healthcare (Syracuse, NY)
- …behavioral health settings. Preferred License, Certification, Association Active, unrestricted Certified Case Manager (CCM) To all current Molina employees: If ... Medicare /Dual Special Needs Populations DSNP, and Medicaid Advantage Plus -FIDE /HIDE DSNP are highly preferred. Prior...per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's… more
