Case Manager For Care Management Services Jobs

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

Knowledge, Skills, & Abilities Required:

Conduct assessments for client needs and develop an individualized service plan to support clients with safety planning, goal setting and psychoeducation.

Assist with applying for public benefits, employment, medical care, return of personal property and short- and long-term coordination of such services.

Minimum of two years of relevant experience.

Excellent communication, organizational and interpersonal skills.

Complete risk-assessments for minor victims of human trafficking and youth at-risk of human trafficking that are referred to Safe Harbour.

Work with the care management team to ensure members’ care needs are met

Deep understanding of the healthcare system, ideally with experience in managed care and Medicare Advantage

Working knowledge of specialists and community resources to assist the member

Ability to multi-task and manage competing priorities with high attention to detail

Proficient skills in Microsoft Office Suite products including Word, PowerPoint, Outlook, and Excel

Ability to function independently in a remote environment with a high level of autonomy

5 plus years’ experience in the pharmaceutical industry (Patient Services, Vendor Management, Specialty Pharmacy Operations)

Experience with understanding benefits, access, and coverage from health insurance carriers

Project Management - Communicates changes and progress; Completes projects on time and budget.

BS Degree with a minimum of 7 plus years’ of overall experience

Experience supporting oral oncolytic via multiple distribution channels

Strong verbal and written communication skills

3+ years of experience managing, coaching or developing staff; 2+ years of program or clinical operations management

Working knowledge of case management systems, community service and delivery systems, and proficiency with Microsoft Office suite.

An active RN license is strongly preferred. Additional state-specific qualifications may be required.

Plan, organize, and oversee timely completion of activities, including assessments, care plans, and discharge planning

Implement and interpret organizational and contractual policies and procedures; regularly review work to ensure policies and guidelines are appropriately applied

Perform other duties and special projects as assigned

Work with the care management team to ensure members’ care needs are met

Deep understanding of the healthcare system, ideally with experience in managed care and Medicare Advantage

Working knowledge of specialists and community resources to assist the member

Ability to multi-task and manage competing priorities with high attention to detail

Proficient skills in Microsoft Office Suite products including Word, PowerPoint, Outlook, and Excel

Ability to function independently in a remote environment with a high level of autonomy

Knowledge of Medicare, Medicaid, patient assessments skills, planning and case management preferred.

Minimum of three to five years of related professional experience, including direct care, case management and leadership or management experience

Actively manage a portfolio of patients, assuring patient and caregiver needs are met within the capabilities of The Association

Performs other related duties as assigned by management.

When supervisory responsibilities are assigned, the requirements are as follow:

Provide information on services and resources and printed/electronic educational materials available to persons with ALS and their families

Knowledge of Medicare, Medicaid, patient assessments skills, planning and case management preferred

Minimum of three to five years of related professional experience, including direct care, case management and leadership or management experience

Actively manage a portfolio of patients, assuring patient and caregiver needs are met within the capabilities of The Association

Performs other related duties as assigned by management.

When supervisory responsibilities are assigned, the requirements are as follow:

Provide information on services and resources and printed/electronic educational materials available to persons with ALS and their families

Previous management experience 2-5 yrs

Applying expertise in TOC case management to identify opportunities for improvement

Be the “go-to” resource for case managers when they are blocked on helping a member advance their goals

Working with individuals to help them become the best case manager they can be including regular 1:1 meetings

Providing feedback on how to improve our technology to enable TOC case managers to better serve patients

A deep caring to make a change in the healthcare experience: you love to serve and make a difference

Provides patient and family education about disease management and expected outcomes

Reporting to the Director of Care Management

Implements case management activities for all age groups that promote continuous improvement in the coordination of care (birth to geriatric)

Additional Benefits: Relocation assistance, tuition reimbursement, free parking

Monitors and manages clinical resource consumption, ensures clinical documentation is accurate

2-4 years of hospital experience in Critical Care, Emergency Medicine or Med-Surg

Prefers working knowledge of case/care management principles.

Prefers working knowledge of principles of utilization management.

Prefers basic knowledge of health care contracts and benefit eligibility requirements.

Encourages member participation and compliance in the case/disease management program efforts.

Completes other assigned functions as requested by management.

Requires a minimum of two (2) years clinical experience.

Certification in Case Management preferred.

Prefer one year experience with discharge planning.

Must have a Master’s in Social Work.

Must have one (1) year or more in Acute Care Setting.

Knowledge of Medicare, Medicaid, patient assessments skills, planning, and case management preferred

Minimum of three to five years of related professional experience, including direct care, case management and leadership or management experience

Actively manage a portfolio of patients, assuring patient and caregiver needs are met within the capabilities of The Association

Performs other related duties as assigned by management.

When supervisory responsibilities are assigned, the requirements are as follows:

Provide information on services and resources and printed/electronic educational materials available to persons with ALS and their families

Experience developing and maintaining case management files.

Tracks the progress of all incoming reports, including management of a centralized database (Maxient). Performs intake tasks for assigned cases.

Knowledge of advising and counseling techniques within educational settings.

Broad knowledge of resources for physical/mental health care and services, crisis prevention, education outreach to faculty, staff, students and parents.

Non-Clinical Case Management, Referrals and Support Services

Master’s degree in higher education, student affairs, counseling, social work, or related field.

1-3 years Two years of clinical experience in a hospital, acute care, home health/hospice, direct care or case management Required

1-3 years Two years of experience in care coordination or case management Required

Home care/field based case management experience preferred.

Knowledge and understanding of case management/coordination of care principles, programs, and processes in either a hospital or outpatient healthcare environment required.

Effective problem-solving skills, including the ability to analyze complex situations, draw conclusions and implement actions appropriately and efficiently.

RN-Registered Nurse - DORA - Department of Regulatory Agencies Required

Management/coordination, health education, health home or community-based experience is preferred

management/coordination, health education, health home or community-based experience is preferred

Maintain accurate and complete documentation of required information in compliance with risk management, regulatory and accreditation requirements

Collect and prepare data, statistics, proposals and reports relevant to responsibilities as a Care Management Associate

Excellent time management and organizational skills

Promote communication, both internally and externally to enhance effectiveness of clinical and nonclinical services and overall case management services

Basic computer skills. Knowledge of Microsoft Office 97: Microsoft Word, Access and Excel, preferred.

Performs related duties as required.

Bachelor's degree in Nursing, required. Master's Degree, preferred.

Current license to practice as a Registered Professional Nurse in New York State.

Knowledge of payer requirements for discharge.

Inside the Care Management Department

Minimum 1 year experience as a Social Worker in an acute healthcare setting.

Developing a comprehensive discharge plan based on the clinician’s assessments and recommendations for ongoing care, and the patient’s health plan guidelines.

Interviewing the patient to review financial, family and psychosocial support in order to identify any barriers to the discharge plan.

Providing psychodynamic intervention, crisis counseling, and end-of-life/bereavement support to patients and families.

Minimum 5 years of experience producing costing analysis of publishable standard

Excellent written English communication skills, with focus on research protocols, research papers and descriptive reports for diverse audience

Working knowledge of Arabic is a strong asset

Democratic, economic and financial governance;

Security and stability of countries in crisis/post-crisis situations;

Strengthening health systems, social protection and employment.

Inside the Care Management Department

Maintaining knowledge of clinical course of patient’s condition in order to appropriately identify post-acute care medical and psychosocial needs.

Understanding of payer requirements for discharge.

Current American Heart Association Healthcare Provider BLS (CPR) Certification

Developing and implementing discharge plans for patients; this includes assessment of clinical, psychosocial, and financial needs of the patient and family.

Coordinating with the interdisciplinary team to gather pertinent clinical information in order to develop a comprehensive discharge plan.