Field RN Case Manager Job at CareGivers America (Clarks Summit)

Manager - Integrated Care

Responsible for developing and managing the day to day processes required to pro...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 years of experience in full-time equivalent of direct clinical care to the consumer
1 year of experience in a supervisory role
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 (a state in the United States) as a Registered Nurse (RN)
or independent license in the behavioral health profession such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.)
Once they have directly supervised the integrated care process within (3) years with the organization, 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 skill in use of office equipment including copier, fax machine, scanner and telephones
Intermediate PC proficiency

Job Responsibility

Manage and oversee all staff activities related to the development and delivery of health improvement/management programs for members with both complex and chronic health care needs
Promotes the integrated, whole-person approach to a continuum of care
Provide oversight and recommendations on the cases being managed through any of the programs
Direct all activities required to maintain accreditation for Case and Utilization Management
Responsible for monitoring and reporting department and program performance measures including IRR
Evaluate, interpret, and negotiate applicable benefit and regulatory requirements
Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person
Responsible for the review, update and accuracy of documentation, computer files, policies and procedures related to the departmental goals and objectives
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and implement operational changes and process improvement
Keep status of unit current in accordance with service standards, systems, procedures, forms and manuals through staff meetings, verbal and written communications

Fulltime

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)
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

Integrated Care Manager - Remote AZ

Location

United States of America , 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

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.)
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

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

Case Manager RN- Field (Central/Eastern Illinois)

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

Location

United States , Springfield

Salary:

66575.00 - 142576.00 USD / Year

CVS Health

Expiration Date

May 31, 2026

Requirements

Minimum 3-5 years clinical practical experience preference required
Minimum 2-3 years CM, discharge planning and/or home health care coordination experience
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Ability to travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
Efficient and Effective computer skills including navigating multiple systems and keyboarding
Registered Nurse with active state license in good standing within the region where job duties are performed is required

Job Responsibility

Acts as a liaison with member/client /family, employer, 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 or in person
May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services
Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status
develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate
Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person
Prepares all required documentation of case work activities as appropriate
Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes
May make outreach to treating physician or specialists concerning course of care and treatment as appropriate

What we offer

Medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
bonus, commission or short-term incentive program

Fulltime

Director, Case Management

Director, Case Management, Baptist Jacksonville The Director of Case Management...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Progressive leadership experience in Case Management, Care Coordination, or Utilization Management within an acute care healthcare environment required
Experience leading inpatient Case Management teams and operational initiatives required
Demonstrated experience with throughput management, discharge planning, length of stay reduction, and readmission prevention initiatives preferred
Strong operational, strategic, and interdisciplinary leadership experience required
Master’s degree in Nursing, Healthcare Administration, Social Work, or related healthcare field required
Current applicable clinical licensure preferred
ACM, CCM, or related Case Management certification preferred
Registered Nurse (RN) - State Nursing Boards
MS preferred

Job Responsibility

Provide strategic and operational leadership for the system-wide inpatient Case Management program across adult hospital campuses
Lead, mentor, and support Managers of Inpatient Case Management while promoting accountability and leadership development
Drive initiatives focused on patient throughput, length of stay reduction, readmission prevention, discharge planning, and capacity management
Collaborate with Social Services leadership to implement integrated, team-based care coordination models
Partner with hospital and health system leadership to improve operational efficiency and patient outcomes
Ensure compliance with regulatory standards, accreditation requirements, and organizational policies related to care coordination and case management
Support patient-centered care transitions and continuity of care across the healthcare continuum
Analyze operational and quality metrics to identify opportunities for process improvement and performance optimization
Foster a culture of collaboration, accountability, service excellence, and continuous improvement

Fulltime

Clinical Care Coordinator

The NDIS Intake NDIS Manager will be responsible for undertaking region wide cli...

Location

Australia , Parramatta

Salary:

80000.00 - 120000.00 / Year

CRT Program

Expiration Date

Until further notice

Requirements

Tertiary Qualification in a clinical health related field such as RN, SW, OT and registration with the relevant board or eligibility for membership of the relevant professional association such registered with APHRA, or ASSW or OT association etc
Experience working within a multidisciplinary team environment, providing case management and coordination of client needs for young people
Demonstrated understanding of the health and wellbeing needs of young adult people with disability care support needs
Demonstrated ability to engage and communicate effectively with young people
Demonstrated ability to undertake assessment and screening of clients and their carers to determine client care needs and assist clients to access necessary services
Well-developed written and verbal communication skills including the ability to deliver small group activities
Proficiency with technology including the ability to use Microsoft Office applications and the capacity to quickly learn new technologies including clinical software packages
Hold a current driver’s licence and have access to a comprehensively insured motor vehicle

Job Responsibility

Actively participate in the implementation of an effective intake and referral service department and managing the intake workloads in time response communicate effectively in collaboration with other DSC department managers and executives
Respond in a timely manner to phone calls and online info enquires generated from the call centre seeking NDIS related services by the participants
Provide Intake eligibility for NDIS service assessments and interventions Follow up arrangement of NDIS consultation meetings in order to engage the participants in DSC NDIS Service Agreement
Provide reports to relevant case managers who are allocated after the Service Agreement secured signed copies from the Participants and Person Responsible
Ensure that all consumer or NDIS participants data is entered accurately and in a timely manner into the electronic information VISICASE management system
Participate in organisation-wide, site based and team meetings, collaborative planning activities and other meetings or activities relevant to position
Contribute to the continuous improvement of systems and processes ensuring services meet professional and industry standards
Work Health and Safety responsibilities as identified in organisational policies and procedures
Equity and diversity responsibilities as identified in organisational policies and procedures

What we offer

Motor vehicle allowance on a per kilometre basis for work-related use of privately-owned vehicle

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Field RN Case Manager

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