Consultant, Managed Care Policy Job at Baptist Health (Florida) (Jacksonville)

Appeals Nurse Consultant

This is a full-time telework position. Hours for this role are Monday-Friday 8a-...

Location

United States

Salary:

Not provided

CVS Health

Expiration Date

Until further notice

Requirements

Must have active and unrestricted RN licensure in state of residence
3+ years clinical experience

Job Responsibility

Responsible for the review and resolution of clinical appeals
Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues
Independently coordinates the clinical resolution with internal/external clinician support as required

Fulltime

Senior Analyst

ATI Advisory is seeking a Senior Analyst to join our growing team. This role is ...

Location

United States , Washington, DC

Salary:

Not provided

ATI Advisory

Expiration Date

Until further notice

Requirements

Graduate degree preferred (public policy, public health, public administration, business, economics, or related field)
2–6 years of relevant experience in consulting, provider strategy, managed care, or health policy analysis
Strong research and analytic skills — both qualitative and quantitative — with a proven ability to synthesize findings into strategic recommendations
Ability to lead tasks, design and execute projects, and mentor junior team members
Exceptional skills in developing and delivering high-quality, client-ready PowerPoint presentations and written reports
Expertise in at least one of the following: Traditional Medicare, Medicare Advantage, value-based care, complex care, long-term care, health plan strategy/operations, or provider strategy/operations
Comfort engaging directly with clients, including presenting findings and facilitating discussions
High initiative and professional maturity, with a strong sense of ownership

Job Responsibility

Partner with senior leaders on client engagements spanning, provider systems, and Medicare/Medicaid policy
Apply critical thinking and creativity to complex problems in data, policy, and strategy
Conduct rigorous qualitative and quantitative research, synthesizing findings into actionable insights for clients
Analyze legislation, regulations, and policies (e.g., Medicare payment rules, PACE, Medicare Advantage, value-based payment, provider payment reform) and assess implications for payers, providers, and markets
Create polished, client-ready deliverables — reports, policy briefs, and compelling PowerPoint presentations — that turn complex analysis into clear narratives and visuals
Take ownership of your work from start to finish across multiple projects and tasks, ensuring accuracy, clarity, and driving client value
Present analyses and recommendations directly to clients and stakeholders
Contribute to ATI’s thought leadership, including external publications, presentations, data analysis synthesis, and commentary on policy and market trends

Senior Eligibility Consultant

Senior Eligibility Consultant role at CVS Health focused on processing policy an...

Location

United States , East Lansing

Salary:

18.50 - 38.82 USD / Hour

CVS Health

Expiration Date

Until further notice

Requirements

2+ years experience as an Eligibility Consultant
Proficiency in processing accurate and timely policy and eligibility data
Understands intent/end state and operates with minimal guidance
Ability to manage multiple tasks and shifting priorities
A team player capable of operating independently when needed
Provides accurate and timely results
Delegates and follows up as needed
Coaches and mentors others
Ability to manage high work volume and oversee a variety of incoming work flows
High School diploma, G.E.D. or equivalent experience

Job Responsibility

Process accurate and timely policy and eligibility data utilizing administration systems
Collaborate with business partners to understand enterprise initiatives and goals
Respond to eligibility and other enrollment related issues
Partner directly with clients, vendors, internal teams to resolve problems
Anticipate and prevent problems and roadblocks before they occur
Solve complex problems and take a new perspective on existing solutions
Design, develop, and deliver transitional training processes
Mentor junior team members
Assist with recommendations involving eligibility reporting solutions
Deliver consulting services in support of data discrepancies

What we offer

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation programs
Weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules

Fulltime

Director of care management services inpatient

UNM Health provides the highest quality of care for more than 200,000 New Mexica...

Location

United States , Albuquerque

Salary:

53.29 - 82.51 USD / Hour

UNM Hospitals

Expiration Date

Until further notice

Requirements

Master's Degree in Health Related Discipline
4 years directly related experience
New Mexico RN or Social Work license

Job Responsibility

Coordinate the planning, implementation and evaluation of the inpatient care management and case management programs
Responsible for the ongoing development of care management implementation strategies
monitoring and evaluation of project outcomes
effectively communicating and integrating the mission, values and strategic initiatives of the hospitals and the Health Sciences Center
Ensure adherence to Hospitals and departmental policies and procedures
Patient care assignment may include neonate, pediatric, adolescent, adult, and geriatric age groups
Adhere to and promote the core expectations of the Patient Centered Medical Home or Patient Centered Specialty Practice as applicable
Participate in the assessment, development, implementation, evaluation, and attendance of educational needs for personnel based on quality assurance indicators
Assist in the development of a care delivery system consistent with changes in patient needs, medical technology and the professions involved with specific case types
Maintain awareness of ongoing Quality Assurance studies within the unit

What we offer

Relocation Assistance Available

Fulltime

AHP Social Worker Assistant

Under the supervision of a licensed social work supervisor but with reasonable i...

Location

United States of America , Rochester

Salary:

24.22 - 33.91 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

BSW from an accredited social work program
3-5 years’ experience in a clinical setting (some ambulatory care experience preferred)
Excellent communication and team skills include ability to form strong collaborative interdisciplinary partnerships across care settings
Sound computer knowledge and skills include an aptitude for using health information technology to guide care management activities and functions
Ability to work independently and meet deadlines
Creativity and strong organizational skills
Valid NYS driver’s license includes access to reliable transportation that enables fulfillment of position’s travel requirements

Job Responsibility

Performs psychosocial assessments of patients and families referred by care managers and providers
Provides social work services and/or consultation in collaboration with care managers for patients with problems identified through psychosocial assessments
Collaborates with other practice care providers in development and implementation of interdisciplinary care plans
Coordinates referrals to and acts as liaison to community agencies regarding services to individual patients in collaboration with care managers
Provides internal and external systems advocacy as indicated in care plans of individual patient in collaboration with the care managers
Maintains current knowledge of community resources relevant to the AHP patient population
Provides appropriate assessment and intervention services for children and adults suspected of being victims of abuse, neglect and/or domestic violence
Participates in relevant training and educational opportunities designed to enhance knowledge and skills
Provides social work consultation to other care providers regarding patient problems and community services
Documents all social work activities in the patients' medical record in accordance with the relevant Social Work Division and AHP practice policies and procedures

Fulltime

Pediatric Nurse NICU

This is a part time 12 hour night shift with every 3rd weekend and a holiday rot...

Location

United States , Milwaukee

Salary:

Not provided

Children's Wisconsin

Expiration Date

Until further notice

Requirements

Minimum of 1 year NICU RN experience for part time schedule
Associate's Degree ADN required
2+ years nursing experience required
BLS-Basic Life Support Healthcare Provider - American Heart Association/American Red Cross/National Safety Council required
License RN-Registered Nurse (30) - State of Wisconsin
License RN-Registered Nurse (TN Compact) - State of Tennessee
License RN-Registered Nurse (NE Compact) - State of Nebraska
NRP certification within 1 year of employment

Job Responsibility

Partner in the care management team
Provides coordination and management of patient care to pediatric patients and families within a continuum of care
Delegates patient care activities as appropriate within a care management assignment
Applies principles of growth and development in obtaining assessment data
Communicates in manner most appropriate for child and family
Identifies and acts upon overt and covert cues of physical, psychosocial and cognitive parameters for an individual
Makes independent nursing decisions and integrates medical plan of care
Performs point of care testing and blood collections according to established policies
Collaborates with physicians and others to implement care management plans
Delegates patient care activities within a care management assignment

What we offer

Hourly night bonus (in addition to shift differentials) after successfully completing orientation
Weekend program bonus program eligibility after completing orientation

Parttime

Pediatric Nurse II- Dialysis

At Children’s Wisconsin, we believe kids deserve the best. Children’s Wisconsin ...

Location

United States , Milwaukee

Salary:

Not provided

Children's Wisconsin

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of nursing
A license to practice professional nursing in the State of Wisconsin
Current CPR certification - Basic Life Support (BLS) for Healthcare Providers through American Heart or American Red Cross
2 years nursing experience

Job Responsibility

Performs as a partner in the Dialysis Unit care management team
Provides coordination and management of patient care to pediatric patients and families within a continuum of care
Delegates patient care activities as appropriate within a care management assignment
Assumes direct care responsibilities of a Dialysis Pediatric Nurse
Shares in the on-call rotation with other dialysis nursing staff
Applies principles of growth and development in obtaining assessment data
Communicates in manner most appropriate for child and family
Identifies and acts upon overt and covert cues of physical, psychosocial and cognitive parameters for an individual
Makes independent nursing decisions and integrates medical plan of care
Understands and satisfies the needs of the neonatal, infant, toddler, pre-school, school-age, adolescent and/or adult patient in regard to their growth and development process

What we offer

$5,000 Sign-On Bonus

Parttime

New

Case Manager - Registered Nurse

We're building a world of health around every individual — shaping a more connec...

Location

United States , Work at Home

Salary:

66575.00 - 142576.00 USD / Year

CVS Health

Expiration Date

May 31, 2026

Requirements

Candidate must have active and unrestricted Compact Registered Nurse (RN) License in their state of residence
3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members

Job Responsibility

Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities
Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work
Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies
Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes
Acts as a liaison with member, family, provider(s), insurance companies, and healthcare personnel as appropriate
Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care
Interacts with members/clients telephonically
Assesses and analyzes injured, acute, or chronically ill members medical
develops a plan of care to facilitate the member appropriate condition management to optimize wellness and medical outcomes, or optimal functioning

What we offer

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources
Bonus, commission or short-term incentive program

Fulltime

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Consultant, Managed Care Policy

Baptist Health (Florida)

Location:
United States , Jacksonville

Category:
Consulting

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
May 20, 2026

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Our AI answers in your language

Consultant, Managed Care Policy

Baptist Health (Florida)

Location:United States , Jacksonville

Category:Consulting

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:May 20, 2026

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Job Posted:
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