RN Care Manager Job at MJHS (New York)

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

RN - Patient Care Manager

Serenity Hospice is seeking an RN Patient Care Manager for our Eugene, Oregon te...

Location

United States , Eugene

Salary:

Not provided

Arcadia Home Care and Staffing - an Addus family company

Expiration Date

Until further notice

Requirements

Possession of a current license to practice as a registered professional nurse or the equivalent license and education to practice as a healthcare professional in the practicing state
Minimum five years’ experience as a healthcare professional
including two years of supervisory experience in healthcare, homecare or hospice
Demonstrated administrative ability including knowledge of health care policies and program responsibilities
Valid driver’s license and proof of insurance is required
Must possess current CPR Certification

Job Responsibility

Oversee delivery of patient services and compliance with agency policies
Develop policies, procedures and guidelines to fulfill program objectives
Oversee scheduling, supervision, and on-going educational programs for all professional and paraprofessional staff providing direct patient services
Implement and monitor a quality assurance program or supervise designated QA staff
Oversee the maintenance of medical records, assuring accuracy, completeness and compliance with licensing regulations, certification standards, legal and ethical standards
Plan and implement staff education program for all team members

What we offer

Great culture and team atmosphere
Comprehensive benefits, including medical, dental, and vision, effective on the first of the month
401(k) retirement plan with a generous company match
Generous time off accruals
Paid holidays
Mileage reimbursement
Tuition Reimbursement
Employee Referral Program
Bonus Eligible
Hospice Certification benefit and salary increase

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

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

Utilization Management RN

As a Utilization Management RN, you will be crucial in ensuring accurate and com...

Location

United States , Bakersfield

Salary:

47.41 - 70.52 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Minimum of 3 years’ recent clinical experience
Graduate of an accredited RN Program
Clear and current CA Registered Nurse (RN) license
Knowledge of nursing theory and ability to apply or modify as appropriate
Knowledge of ICD-10, CPT, HCPCS coding, medical terminology and insurance benefits
Knowledge of legal and ethical considerations related to patient information, PHI and HIPAA regulations

Job Responsibility

Authorization Review: Proactively, concurrently, or retroactively reviewing referral authorization requests, gathering necessary information, and escalating to the Medical Director when needed
Compliance & Accuracy: Meeting turnaround times and accuracy standards
Provider Network: Ensuring authorized services are with contracted providers and coordinating with contracting for new agreements
Care Coordination: Identifying cases for additional case management and collaborating with internal departments to coordinate patient care
Quality & Cost-Effectiveness: Adhering strictly to utilization management policies to promote quality, cost-effective care
Denial Notice Composition: Drafting compliant, clear, and member-specific denial letters in accordance with federal, state, and health plan regulations, as well as NCQA standards

What we offer

medical, prescription drug, dental, vision plans, life insurance, paid time off, tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, Health Spending Account (HSA), Long Term Disability, 401k retirement plan with a generous employer-match, Sick Leave

Fulltime

Clinical Manager Hospice RN

Are you looking for a rewarding career in hospice? If so, we invite you to join ...

Location

United States , Toms River

Salary:

115000.00 - 120000.00 USD / Year

Amedisys

Expiration Date

Until further notice

Requirements

Associate or bachelors degree in nursing
One year of clinical RN experience in home health or hospice
One year of RN management experience
Current RN license, specific to the state(s) you are assigned to work
Current CPR certification

Job Responsibility

Supports, participates and works cooperatively with the director of staffing
Responsible for overall quality of patient care and clinical performance of nurses and aides
Organizes clinical operations for the care center
Reviews requests for services and determines patient eligibility/suitability for home care services
Works with intake in coordinating patient referrals and admissions
Oversees scheduling
Oversees payor verification and precertification requirements
Reviews documentation of other staff members and ensures missing, incomplete and/or untimely documentation issues are resolved
Assists clinicians in establishing immediate and long-term patient goals, setting priorities and developing Plan of Care (POC)
Regularly evaluates the needs of the patient and makes necessary revisions to the plan of care in collaboration with clinicians

What we offer

A full benefits package with choice of affordable PPO or HSA medical plans
Paid time off
Up to $1,000 in free healthcare services paid by Amedisys yearly, when enrolled in an Amedisys HSA medical plan
Up to $500 in wellness rewards for completing activities during the year
Mental health support, including up to five free counseling sessions per year through the Amedisys Employee Assistance program
401(k) with a company match
Family support with infertility treatment coverage, adoption reimbursement, paid parental and family caregiver leave
Fleet vehicle program (restrictions apply) and mileage reimbursement

Fulltime

RN Case Manager Hospice

Are you looking for a rewarding career in hospice? If so, we invite you to join ...

Location

United States , Hyannis

Salary:

93000.00 - 97000.00 USD / Year

Amedisys

Expiration Date

Until further notice

Requirements

One year of nursing experience
Current RN license, specific to the state(s) you are assigned to work
Current CPR certification
Valid driver's license, reliable transportation and liability insurance

Job Responsibility

Performs patient assessments and collaborates with the care team to develop and implement a plan of care
Makes referrals to other hospice care disciplines as needed or documents rationale for not doing so
Develops, prepares, and maintains individualized patient care progress records with accuracy, timeliness and according to care center policies
Records pain/symptom management changes/outcomes as appropriate
Teaches patients, families, and caregivers appropriate patient care techniques
Regularly communicates with clinical manager and care team
Performs on-call responsibilities and on-call services to patients/families as assigned
Other duties as assigned

What we offer

$7,500 Sign-on Bonus
A full benefits package with choice of affordable PPO or HSA medical plans
Paid time off
Up to $1,000 in free healthcare services paid by Amedisys yearly, when enrolled in an Amedisys HSA medical plan
Up to $500 in wellness rewards for completing activities during the year
Mental health support, including up to five free counseling sessions per year through the Amedisys Employee Assistance program
401(k) with a company match
Family support with infertility treatment coverage, adoption reimbursement, paid parental and family caregiver leave
Fleet vehicle program (restrictions apply) and mileage reimbursement

Fulltime

RN Clinical Care Guide

The Clinical Care Guide (RN) will be a key contributor to our first-class care t...

Location

United States , Scottsdale

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

Current state license to practice as a Registered Nurse
BLS certification
Electronic Medicare Records experience
Customer service orientation and experience
Strong communication skills across multiple modalities
Highly collaborative
Empathy and advocacy
Exceptional organizing skills, detail-orientation
Must be able to maintain confidentiality at all times
Active AZ fingerprint clearance card

Job Responsibility

Support members both in-person and virtually with real-time consultation, education, scheduling of specialist & diagnostic referral appointments, and follow-through + follow-up of those appointments
Play a critical role in the achievement of improved health outcomes and cost savings
Be an empathetic problem-solver and become the most visible partner to all patients
Clarify and explain referral for specialist and diagnostic service recommendations
Care for end to end process as needed, for referral or specialist services
Lead center in development and management of quality programs to include patient outreach to members in an effort to provide an elevated primary care experience with gaps in care or other clinical needs
Support members with chronic conditions by providing education, reminders, and other support
Handle the management and integration of office processes
Lead service and schedule requests on member’s behalf
Inform and equip Care Team with referral information and requirements

Fulltime

RN Care Manager

MJHS

Location:
United States , New York

Category:
Nursing

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
January 22, 2026

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Location:United States , New York

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Job Description:

Job Responsibility:

Requirements:

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