Pt care manager Job at Dewolfe Place (Findlay)

Medical Appeals/Grievance Specialist II - Registered Nurse

Responsible for utilizing clinical acumen and managed care expertise related to ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

1 year experience in clinical and health insurance or other healthcare related field
3 years experience in clinical and health insurance or other healthcare related field AND 1 year Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
5 years experience in clinical and health insurance or other healthcare related field AND 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
8 years experience in clinical and health insurance or other healthcare related field AND 3 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
Associate’s Degree in a healthcare field of study or Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN), a Physical Therapist (PT) or a Licensed Master Social Worker LMSW.
Intermediate PC proficiency
Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
Maintain complete and accurate records per department policy.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Attend staff and interdepartmental meetings.
Participate in continuing education and current developments in the fields of medicine and managed care.

Fulltime

Staff Pharmacist PT

At CVS Health, we’re building a world of health around every consumer and surrou...

Location

United States , Pampa, Texas

Salary:

60.00 - 74.00 USD / Hour

CVS Health

Expiration Date

March 31, 2026

Requirements

Active Pharmacy License in the state in which you are employed
Not on the DEA Excluded Parties List
Immunization Certification through an accredited organization (i.e. APhA)
Free of pending felony charges or convictions for criminal offenses involving controlled substances

Job Responsibility

Patient Safety
Pharmacy Professional Practice
Regulatory Requirements
Quality Assurance
Customer Service
Personnel Management
Inventory Management
Financial Profitability
Loss Prevention
Workflow Management

What we offer

Affordable medical plan options
401(k) plan (including matching company contributions)
employee stock purchase plan
wellness screenings
tobacco cessation and weight management programs
confidential counseling
financial coaching
paid time off
flexible work schedules
family leave

Parttime

Director of Rehabilitation

Our client is rapidly growing provider of therapy services throughout the US. Th...

Location

United States , Vallejo

Salary:

Not provided

Above All Talent Solutions

Expiration Date

Until further notice

Requirements

Must have current, unrestricted license, in state of practice
Must have Long Term Care experience
Must be a licensed COTA, OT or PT Director of Rehabilitation
Must have a degree in physical therapy, occupational therapy, or speech therapy
Experience in the field of rehabilitation is required
Demonstration of managerial practices is required
Extensive knowledge of the rehab's goals and the ability to convey this knowledge to the employees is required

Job Responsibility

Insure that all therapists working under the director are responding to the patients within the facility adequately
Keep up to date on licenses that are required by each individual therapist
Review reports from each individual patient requiring rehabilitation
Provide hands-on services to patients
Lead on creating and implementing programs with the clients inside the facility
Deem a patient rehabilitated and clear them from the facility
Be at a desk reviewing reports unless an observation of patients is required
Frequent walking to follow up on patients' progress
Meetings with patients in order to determine if the patients are able to be released from rehab

What we offer

Phenomenal Culture
Competitive Compensation
Medical/Dental/Vision
Supplemental Insurance Programs
401-K with Employer Match
Advancement Opportunities
Fun, friendly work environment
Paid Time Off (PTO) Program
Referral Bonuses

Fulltime

Pt care manager

The Care Giver's role includes providing hands-on care and physical and emotiona...

Location

United States , Findlay

Salary:

Not provided

Dewolfe Place

Expiration Date

Until further notice

Requirements

Certified Nurse’s Aid certification preferred
High School diploma/GED
Must be 18 years of age
Previous experience working with seniors preferred
Ability to communicate effectively with Residents, management, and co-workers
Superior customer service skills
Ability to handle multiple priorities
Must demonstrate good judgment, problem-solving, and decision-making skills

Job Responsibility

Maintaining cleanliness of resident’s room and work areas
Helping residents maintain independence, promoting dignity and physical safety of each resident
Participating and assisting residents with activities of daily living (i.e. bathing, dressing, toileting, grooming, ambulation, transferring, eating) as instructed
Engaging residents in life skills and other life enrichment activities

What we offer

Medical
dental
vision
life and disability insurances
paid time off
paid holidays
401(k) plan with company match
Employee Assistance Program
accident insurance policies

Parttime

Pt care manager 2nd shift

The Care Giver's role includes providing hands-on care and physical and emotiona...

Location

United States , Findlay

Salary:

Not provided

Dewolfe Place

Expiration Date

Until further notice

Requirements

Certified Nurse’s Aid certification preferred
High School diploma/GED
Must be 18 years of age
Previous experience working with seniors preferred
Ability to communicate effectively with Residents, management, and co-workers
Superior customer service skills
Ability to handle multiple priorities
Must demonstrate good judgment, problem-solving, and decision-making skills

Job Responsibility

Maintaining cleanliness of resident’s room and work areas
Helping residents maintain independence, promoting dignity and physical safety of each resident
Participating and assisting residents with activities of daily living (i.e. bathing, dressing, toileting, grooming, ambulation, transferring, eating) as instructed
Engaging residents in life skills and other life enrichment activities

What we offer

medical
dental
vision
life and disability insurances
paid time off
paid holidays
401(k) plan with company match
Employee Assistance Program
accident insurance policies

Case Manager

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

Location

United States , Houston

Salary:

37.83 - 53.66 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

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

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

Pt care manager

Dewolfe Place

Location:
United States , Findlay

Category:
Nursing

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
December 08, 2025

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