Certified Case Manager Job at Encompass Health (Overland Park)

Integrated Care Manager

Responsible for promoting continuity of care through a collaborative process tha...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC).

Job Responsibility

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan
Answer a diverse and high volume of health insurance related customer calls on a daily basis
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy
Demonstrate ability to apply plan policies and procedures effectively

Fulltime

New

Integrated Care Manager - Adult

Responsible for promoting continuity of care through a collaborative process tha...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC)
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge

Job Responsibility

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan
Answer a diverse and high volume of health insurance related customer calls on a daily basis
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy
Demonstrate ability to apply plan policies and procedures effectively

Fulltime

Embedded Transitional Care Manager RN

Oak Street Health takes a team-based approach to providing outstanding patient c...

Location

United States , Rockford

Salary:

66575.00 - 142576.00 USD / Year

CVS Health

Expiration Date

Until further notice

Requirements

An active RN license within the state of practice in good standing
Willingness to obtain cross-state licensure, as needed
Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire
2+ years’ experience in transitional nursing, discharge planning, nursing case management, or home health
Experience in utilization management preferred
Knowledge of Medicare/Medicaid and NCQA regulatory transitions of care criteria
Exceptional communication skills and customer service orientation
Innovative and independent problem solving skills
Ability to monitor and evaluate opportunities for cost-effective care options with high-quality outcomes
Spanish-speaking preferred but not required

Job Responsibility

Manage patients through transitions of care
Advocate for the patient throughout the care continuum
Identify opportunities for improved program workflows
Maintain real-time and accurate records of patient status
Adhere to CMS, state specific and NCQA compliance criteria
Evaluate patient status post-ED visit or observation stay
Triage to determine appropriate follow up care
Engage directly with inpatient physicians, case managers, medical directors, and hospitalists
Coordinate with the Utilization Management team
Conduct structured clinical assessment to identify post-discharge needs

What we offer

Paid vacation, sick time, and investment/retirement 401K match options
Health insurance, vision, and dental benefits
Affordable medical plan options
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access

Fulltime

Embedded Transitional Care Manager

The Embedded Transitional Care Manager - RN (TCM-RN) plays a critical role in en...

Location

United States , Indianapolis

Salary:

54095.00 - 116760.00 USD / Year

CVS Health

Expiration Date

Until further notice

Requirements

An active RN license within the state of practice in good standing
willingness to obtain cross-state licensure, as needed
Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire
2+ years’ experience in transitional nursing, discharge planning, nursing case management, or home health
experience in utilization management preferred
knowledge of Medicare/Medicaid and NCQA regulatory transitions of care criteria
exceptional communication skills and customer service orientation
innovative and independent problem-solving skills
ability to monitor and evaluate opportunities for cost-effective care options with high-quality outcomes
Spanish-speaking preferred but not required

Job Responsibility

Manage patients through transitions of care, either face to face in the facility or telephonically
advocate for the patient throughout the care continuum
identify opportunities for workflow improvements and partnerships
maintain real-time records of patient transitions
engage with physicians, case managers, and hospitalists
coordinate follow-up care, medication reconciliation, and discharge planning
collaborate with internal stakeholders and regional leaders on transitions initiatives
participate in training, documentation, tracking, and quality assurance

What we offer

Mission-focused career
paid vacation and sick time
investment/retirement 401K match options
health insurance, vision, and dental benefits
affordable medical plan options
no-cost programs for health and wellness
tuition assistance
flexible schedules
family leave
dependent care resources

Fulltime

New

Director Care Coordination

As our Director of Care Coordination, you will be responsible for leading, facil...

Location

United States , Gilbert

Salary:

57.37 - 85.33 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Minimum Bachelors of Nursing required or Master's in Social Work
Seven years administrative and health care system experience
Seven years of clinical and care management experience
Five years of leadership experience
Registered Nurse: AZ
Certified Case Manager upon hire
Accredited Case Manager upon hire

Job Responsibility

Lead, facilitate, and implement strategies to optimize patient care coordination and outcomes
Oversee the comprehensive care coordination functions, ensuring seamless transitions, efficient resource utilization, and patient-centered approaches
Work closely with interdisciplinary teams, physicians, and leadership to enhance clinical effectiveness, patient satisfaction, and alignment with system goals
Drive continuous improvement initiatives, analyze performance metrics, and ensure adherence to best practices and regulatory standards
Oversee the daily operations of the Care Coordination program, ensuring accountability, effectiveness, efficiency, and compliance with regulatory and accreditation agencies
Accept multiple management tasks to handle financial, operations, managed care & staffing issues within the Care Management departments
Serve as clinical advisor to care management across the continuum of care for all programs
Analyze data and develop strategies and action plans to address opportunities for improvement
Develop department and division strategies to ensure efficient operations and goal achievement
Maintain relationships with medical staff members, CNO, nurse VPs, Directors/managers, department managers and technical Directors

What we offer

Medical
Prescription drug
Dental
Vision plans
Life insurance
Paid time off (minimum of 14 days including holidays annually for full-time benefit eligible team members)
Tuition reimbursement
Retirement plan benefit(s) including 401(k), 403(b), and other defined benefits offerings

Fulltime

New

Case Manager

Recognized for your abilities as a Case Manager. Are you ready for a Case Manage...

Location

United States , Tucson

Salary:

30.00 - 48.00 USD / Hour

Encompass Health

Expiration Date

Until further notice

Requirements

Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (for example, RN, SW, OT, PT, ST, and Rehabilitation Counseling)
If licensure is required for one's discipline within the state, individual must hold an active license
Must meet eligibility requirements for CCM® or ACM™ certification upon entry into this position OR within two years of entry into the position
CCM® or ACM™ certification required OR must be obtained within two years of being placed in the Case Manager II position
For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN preferred. A diploma is acceptable only in those states whose minimum requirement for licensure or certification is a diploma rather than an Associate Degree
For all other eligible licensed or certified health care professionals, must possess a minimum of a bachelor's degree and graduate degree is preferred
2 years of rehabilitation experience preferred

Job Responsibility

Work with interdisciplinary team, guiding treatment plans based on patient needs and preferences
Coordinate with interdisciplinary team to establish tentative discharge plan and contingency plans
Participate in planning for and the execution of patient discharge experience
Monitor patient experience: quality/timeliness/service appropriateness/payors/expectations
Facilitate team conferences weekly and coordinate all treatment plan modifications
Complete case management addendums and all required documentation
Maintain knowledge of regulations/standards, company policies/procedures, and department operations
Review/analyze case management reports, including Key Care Indicators, and plan appropriate actions
Understand commercial contract levels, exclusions, payor requirements, and recertification needs
Attend Acute Care Transfer (ACT) meetings to identify trends and collaboratively reduce ACTs

What we offer

Affordable medical, dental, and vision plans for both full-time and part-time employees and their families
Generous paid time off that accrues over time
Opportunities for tuition reimbursement and continuous education
Company-matching 401(k) and employee stock purchase plans
Flexible spending and health savings accounts
A vibrant community of individuals passionate about the work they do

New

Case Manager

Recognized for your abilities as a Case Manager. Are you ready for a Case Manage...

Location

United States , Portland

Salary:

Not provided

Encompass Health

Expiration Date

Until further notice

Requirements

Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (for example, RN, SW, OT, PT, ST, and Rehabilitation Counseling)
If licensure is required for one's discipline within the state, individual must hold an active license
Must meet eligibility requirements for CCM® or ACM™ certification upon entry into this position OR within two years of entry into the position
CCM® or ACM™ certification required OR must be obtained within two years of being placed in the Case Manager II position
For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN preferred. A diploma is acceptable only in those states whose minimum requirement for licensure or certification is a diploma rather than an Associate Degree
For all other eligible licensed or certified health care professionals, must possess a minimum of a bachelor's degree and graduate degree is preferred
2 years of rehabilitation experience preferred

Job Responsibility

Work with interdisciplinary team, guiding treatment plans based on patient needs and preferences
Coordinate with interdisciplinary team to establish tentative discharge plan and contingency plans
Participate in planning for and the execution of patient discharge experience
Monitor patient experience: quality/timeliness/service appropriateness/payors/expectations
Facilitate team conferences weekly and coordinate all treatment plan modifications
Complete case management addendums and all required documentation
Maintain knowledge of regulations/standards, company policies/procedures, and department operations
Review/analyze case management reports, including Key Care Indicators, and plan appropriate actions
Understand commercial contract levels, exclusions, payor requirements, and recertification needs
Attend Acute Care Transfer (ACT) meetings to identify trends and collaboratively reduce ACTs

What we offer

Affordable medical, dental, and vision plans for both full-time and part-time employees and their families
Generous paid time off that accrues over time
Opportunities for tuition reimbursement and continuous education
Company-matching 401(k) and employee stock purchase plans
Flexible spending and health savings accounts
A vibrant community of individuals passionate about the work they do

New

Case Manager

Recognized for your abilities as a Case Manager. Are you ready for a Case Manage...

Location

United States , Owasso

Salary:

32.14 - 41.83 USD / Hour

Encompass Health

Expiration Date

Until further notice

Requirements

Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (for example, RN, SW, OT, PT, ST, and Rehabilitation Counseling)
If licensure is required for one's discipline within the state, individual must hold an active license
Must meet eligibility requirements for CCM® or ACM™ certification upon entry into this position OR within two years of entry into the position
CCM® or ACM™ certification required OR must be obtained within two years of being placed in the Case Manager II position
For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN preferred. A diploma is acceptable only in those states whose minimum requirement for licensure or certification is a diploma rather than an Associate Degree
For all other eligible licensed or certified health care professionals, must possess a minimum of a bachelor's degree and graduate degree is preferred
2 years of rehabilitation experience preferred

Job Responsibility

Work with interdisciplinary team, guiding treatment plans based on patient needs and preferences
Coordinate with interdisciplinary team to establish tentative discharge plan and contingency plans
Participate in planning for and the execution of patient discharge experience
Monitor patient experience: quality/timeliness/service appropriateness/payors/expectations
Facilitate team conferences weekly and coordinate all treatment plan modifications
Complete case management addendums and all required documentation
Maintain knowledge of regulations/standards, company policies/procedures, and department operations
Review/analyze case management reports, including Key Care Indicators, and plan appropriate actions
Understand commercial contract levels, exclusions, payor requirements, and recertification needs
Attend Acute Care Transfer (ACT) meetings to identify trends and collaboratively reduce ACTs

What we offer

Affordable medical, dental, and vision plans for both full-time and part-time employees and their families
Generous paid time off that accrues over time
Opportunities for tuition reimbursement and continuous education
Company-matching 401(k) and employee stock purchase plans
Flexible spending and health savings accounts

Parttime

Certified Case Manager

Encompass Health

Location:
United States , Overland Park

Category:
Nursing

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
January 05, 2026

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