Case Management Analyst Jobs

Achieve required phone and transaction performance as defined by VP, Case Management.

Adhere to company policies and legal requirements regarding personal health information.

­Excellent verbal, written and interpersonal communication skills.

A competitive salary commensurate with experience.

Stay current on medical facility and life insurance carrier policies, operational process flows and compliance criteria.

Strong attention to detail, highly organized and ability to maintain accuracy under time constraints.

Previous TRICARE, managed care, or case/care/utilization management experience preferred

Receives, logs-in and distributes all case management referrals

Provides administrative support to department management and staff, such as distributing mail, correspondence, ordering office supplies, scheduling meetings and faxing documents

Handles phone call- backs for the Care Managers, schedules beneficiary appointments

Assists in the entry of Care Manager notes when needed

Contacts provider offices to gather data as needed for reports, problem resolution or to explain benefits

Previous experience working in correspondence and document management systems, with specific emphasis on FOIA and other case management actions.

Experience with Microsoft Dynamics 365.

Previous experience with DOT is preferred, but not required.

Receives incoming requests, uploads requests into the tracking system(s), and tracks to resolution.

Formats, compiles, redacts personal identifying information (PII) and creates inventory lists.

Prepares FOIA documents for uploading to the public docket.

Share lessons learned from case management in forums such as BULT (Business Unit Legal Team), Patent Litigation and LCMT meetings.

Bachelor's Degree and a minimum of 3 years litigation paralegal experience.

Or High School diploma/GED and 7 years of relevant litigation paralegal experience.

Ability to assess and manage risk in a highly regulated environment.

Strong written, spoken and presentation communication skills.

Demonstrated negotiation and influence skills.

Reviews daily admission data and checks inpatient insurance benefits, authorized days and concurrent review requirements.

Performs admission, concurrent and retrospective reviews under the direction of the Case Manager, following established guidelines.

Verifies post-hospitalization benefits. Arranges and coordinates transportation, post-hospital placement, services and equipment.

Three (3) years of progressively responsible and directly related work experience

Knowledge of Windows-based office software, computers and operating systems

SHC Commitment to Providing an Exceptional Patient & Family Experience

Gather, scan, and store required program eligibility and other required information in electronic databases and case management systems

Experience facilitating client applications to public benefit programs

Communicate with applicants by phone, email and in-person to explain program requirements, obtain documents and provide case status

Assist case managers with their daily tasks

Must have fluent verbal and written communication skills, bilingual Spanish and English

Bachelor's degree or 4+ years professional experience

Case Management and/or home care experience preferred.

Case management certification highly preferred.

The CM ensures that the patient/family agrees with and understands this transition plan and that the plan is implemented appropriately.

Works in collaboration with utilization review nurse to ensure that reviews are completed timely.

Bachelor of Science in Nursing (BSN) highly desired.

Current BLS for Health Care Provider from American Heart Association.

Comprehensive knowledge of case management, discharge planning, utilization management and community resources. Strong supervisory, communication and negotiation skills.

Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements

Case Management, Quality or other equivalent certification that is related to the specific area to be managed is required.

Establish operational objectives for department or functional area and participate with other managers to establish group objectives

Be responsible for team, department, or functional area results in terms of planning, cost in collaboration with Sr Manager

Participate in the development and implementation of the annual budget under the direction of the Director

Reports adverse events and near misses to appropriate management authority.

One year professional experience performing mental health services is required. Experience with those having serious and persistent mental illness preferred.

Knowledge of community resources is essential. Knowledge of relevant criteria and application process is desirable.

Bachelor’s Degree in social work or a related field is required.

Current, valid, MD state driver’s license is required. Use of employees own personal vehicle is required.

Must have demonstrated interest in community outreach.

Experience with data entry and management

Coordinating with care managers, community health workers, and support staff regarding member information required to complete accurate data entry.

Provide data management support as needed

Associate’s Degree or other formal health education / certification is preferred

Medicaid, Medicare and Managed Care experience is preferred

Review medical documentation to identify relevant data and extract required information needed to complete data entry fields.

Screening and assessment skills and expertise in care coordination and/or utilization management in a health care setting required.

Minimum Education and Experience Requirements:

Five or more years of related experience may be substituted for the credentials.

BSW, bachelor's degree or LPN required.

Active and current appropriate licensure through the Department of Professional Regulation, State of Florida, as indicated.

Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements

Provides Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD).

A minimum of 1 year experience in inpatient, outpatient or managed care environment required

Health insurance/managed care experience desired.

Requires at least 5 years of prior experience in nursing, healthcare or related field

Transitions of care experience desired

Comprehensive knowledge of case management, discharge planning, utilization management and community resources. Strong supervisory, communication and negotiation skills.

Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements

Case Management, Quality or other equivalent certification that is related to the specific area to be managed is required.

Establish operational objectives for department or functional area and participate with other managers to establish group objectives

Be responsible for team, department, or functional area results in terms of planning, cost in collaboration with Sr Manager

Participate in the development and implementation of the annual budget under the direction of the Director

Solid organization and time management skills.

At least one-year experience working with individuals with intellectual and developmental disabilities.

Experience conducting individual assessments with knowledge of behavior rating or psychological testing principles.

Knowledge and experience with person-planning concepts.

Prior experience conducting the Supports Intensity Scale assessment is preferred.

Experience with Home and Community Based Services waivers preferred.

1+ year(s) of case management experience required.

Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.

Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

Helps member actively and knowledgeably participate with their provider in healthcare decision-making.

1+ year(s) of experience with MS Office Suite applications (Outlook, Word, Excel, SharePoint).

Leadership, experience, and creativity in approaches to the management of complex patient care.

If you are relying on your education to meet qualification requirements:

Wide background of experience, an intuitive grasp of clinical situations, and capability to make efficient and timely diagnoses.

Ability to apply advanced clinical knowledge and judgment in a multidisciplinary care environment.

Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).

1-2 years of APRN experience preferred;

Case management and discharge planning experience.

Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.

2+ years of experience with personal computers, keyboard and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint).

2+ year of experience with Ohio delivery systems, including local community networks and resources.

Enhancement of Medical Appropriateness and Quality of Care:

Monitoring, Evaluation and Documentation of Care:

Review specific cases and authorize benefits as required.

Proficient knowledge of WMS, HRA One Viewer, Microsoft Outlook, Excel, Word and Access.

Strong research and problem-solving skills.

Review the accuracy and timeliness of reports, including all relevant worklists.

Act as liaison to the Rental Assistance Unit.

Conduct daily sweeps to ensure timely and proper service.