10 Case Manager Nurse jobs

Full or Part time Case Manager for established Home Healthcare Agency

Are you a driven Occupational Therapist seeking an amazing opportunity that offers both professional fulfillment and a gorgeous location? Then look no further. ICON Medical Network is seeking passionate, driven individuals for our esteemed medical clients throughout the country. One such client in California needs an Occupational Therapist to help them in their mission of providing quality patient care. If you think that person could be you, read on for more details!   ESSENTIAL FUNCTIONS A successful Occupational Therapist at this facility does the following: Directs and supervises the work of assistants, rehab aides and students as applicable with State and Federal guidelines. Develops treatment plan and provides treatment, consistent with benefit and reimbursement level, to assure best functional outcome for patient. Follows all organizational and facility safety procedures regarding one's personal protection and patient safety. Educates staff, other health care professionals and third party payer on the benefits and functional outcomes of intervention. Assures compliance with Occupational Therapy code of ethics and OT practice in the State of California. Appropriately and effectively completes documentation including evaluations, daily progress notes, summaries, or monthly reports as required. Participates in: care plan meetings, rehab meetings and family training, in order to communicate patient status during therapy. Attends continuing education seminars/workshops to keep abreast of new clinical skills, programs or techniques.  Provides in-service training sessions or other educational presentations to company, team or facility in order to enhance one's clinical and professional knowledge and skills. Maintains appropriate state licensure, certification and credentialing. Submits billing, payroll, and expense documentation in a timely manner. Makes appropriate referrals to other members of the rehab team. Conforms to all safety rules and use all appropriate safety equipment. Anything else as your supervisor and/or upper management may assign and/or require. CRITERIA Here's what you need to apply: Education Required:  Minimum of Bachelor of Science in Occupational Therapy.  Masters Degree in Occupational Therapy, preferred.   Licensure/Certification:  Licensure as required by State guidelines. Registered through NBCOT is optional. CPR Certification. Physical Agent Modalities Certification, preferred. Experience:  1 year Occupational Therapy experience, preferred. 1-2 years experience in a residential/assisted living or skilled nursing facility, preferred. New graduates considered. If you meet the criteria and think you're up to the task, apply now! We're thrilled to help you pursue this exciting opportunity.  Reference Number: 10773578 NursEmp Reference Number: NursEmp_ID_389146

The Director of Utilization and Case Management is accountable for the Managed Care Division’s Florida based clinical program operations, including Managed Care Chronic Case Management, Utilization Management, Waiver programs and Ryan White Medical Case Management.     Responsibilities: Duties and Responsibilities include but are not limited to:   Collaborates with all managed care departments and AHF functions to develop and maintain Managed Care clinical programs, including the Chronic Care Model, which is the basis for the Case Management Program.. Works closely with management and staff to facilitate adherence to Plan operational standards and regulations. Responsible for Project Management related to clinical programs, including specific regulatory required processes and program enhancements. Assures timely reporting of required data through the Quality Management Committees and contracted private and/or governmental agencies and the Board of Directors,  including the annual UM Program Description, Workplan and annual UM Program Summary. Ensures there is appropriate monitoring of staff and department outcomes relative to performance objectives, including individual and collective feedback to the clinical team. Demonstrates comprehensive knowledge of Agency for Health Care Administration (AHCA), and Medicare (CMS) Medicare Advantage and Part D regulations as they pertain to managed care clinical operations. Collaborates with all managed care departments to ensure operational effectiveness of the Clinical Programs. Establishes measureable performance goals for staff and department programs including, UM, CM, MTMP, Ryan White and Waiver Medical Case Management Programs. Is an active participant in the preparation and execution of the Utilization Management Committee. Regularly attends and participates in the bi-weekly FL Operations meeting Reports UM/CM Department performance and outcomes to appropriate committees. Collaborates and cooperates with the Compliance Officer to ensure programmatic compliance to regulatory guidance in assigned areas. Assists with development of the operational budget and allocation of resources. Participates in Contracting and Provider Relations activities as necessary to develop and maintain provider networks based on member need. Ensures the appropriate authorization and appeals processes per regulatory requirements.  Collaborates with the Medical Director to ensure the Clinical appropriateness of programs and process.   Management Responsibilities Demonstrates the ability to organize and facilitate effective meetings. Develops project plans, coordinates projects and communicates project outcomes Responsible for hiring, training and motivating staff Mentors and develops the Manager of UM/CM, case managers, and others, as needed, on the team Disciplines in conjunction with Human Resources and AHF guidelines Addresses concerns and resolves issues   Participates in AHF Meetings/Committees Attends AHF and Managed Care Committees including: Quality Management Committee, Pharmacy and Therapeutics Utilization Management Committee Member Provider Committee Medical Staff Committee   Qualifications: To perform this job successfully, an individual must be able to satisfactorily perform the essential duties.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience •    Graduate from an accredited RN program  •    Current, unrestricted FL RN license •    BS in Nursing or other healthcare field •    Masters Degree preferred or demonstrated comparable managerial and executive experience •    Minimum of five years experience in managed care with emphasis in Medicaid and Medicare. Computer/Software Skills & Abilities To perform this job successfully, an individual should have knowledge of standard business software, including but not limited to: word processing, spreadsheet software, presentation software, experience with relational database principles and functions, and a basic understanding of claims administration principles is required. Language Skills Ability to read, analyze, and interpret the most complex documents. Ability to respond effectively to the most sensitive inquiries or issues.  Ability to effectively present information to top management or public groups. Mathematical Skills High mathematical skills required. Ability to apply mathematical principles to practical solutions, using fractions, percentages, ratios, and proportions. Reasoning Ability Ability to define problems, collect data, establish facts, and draw valid conclusions.   Travel:   Travel locally and in the domestic United States up to 40% of the time Other Skills & Abilities/Qualifications Ability to successfully work with various levels of professional and non-professional staff. Must be able to work independently and as a part of a team. Knowledge of HIV/AIDS, related medical and patient care issues and concerns in diverse populations. Certificates, Licenses and Registrations Current unrestricted FL RN License required CCM preferred

AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation! Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees? If so, AIDS Healthcare Foundation is the place for you! Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them. AHF’s core values are: • Patient-Centered • Value Employees • Respect for Diversity • Nimble • Fight for What’s Right   STILL INTERESTED? Please continue!     Responsibilities:   The Ryan White Registered Nurse Medical Case Manager (MCM) contributes to the success of the Medical Care Management Programs by managing the daily work flow to achieve high quality care management delivery and positive clinical outcomes, promote client retention in care, adherence to prescribed medical and medication therapies, while meeting the administrative and contractual performance targets, documentation standards and billing requirements of the  Medical Care Management Programs.   In addition: The RN Medical Case Manager provides case management services to manage and maintain patients in care in order to improve health outcomes. Provide a link for clients to appropriate entitlement and support services and serves as a portal for critical client education. The MCM screen cases for possible case management services according to the contract and RW jurisdiction’s predetermined criteria, evaluates physician's treatment plan and other records to develop a care plan to assist patient to maintain adherence to medications, appointments and other medical follow up, consults with providers, clients and family members as needed, documents all initial and concurrent reviews, including, but not limited to diagnosis, symptoms, interventions, goals and plan for next review Essential Duties & Responsibilities To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Includes the following.  Other duties may be assigned. Maintains extensive knowledge regarding the current standards of HIV/AIDS care and case management processes. Attends all required educational events, e.g., HIPAA, Fraud/Waste/Abuse, Cultural and Linguistic Sensitivity, DOH-HASTA trainings, and HIV updates. Disseminates information and educates the provider community and patients regarding the latest treatment protocols in HIV/AIDS management. Maintains current knowledge of the District HIV Medical Case Management Guidelines, 2014 second edition or newer. Interviews patients and families to assess needs and risk categories to develop and implement appropriate plans of care and assessments Establishes long and short term goals for the patient/family which are S-M-A-R-T  (Smart, Measurable, Achievable, Realistic, Timely) Creates an individualized plan of action in collaboration with the patient, family, medical caregivers and community agencies.  Implements, monitors and evaluates the plan of care and its effectiveness.  Revises as necessary. Monitors hospital, emergency room, outpatient and ancillary services; lab values and patient satisfaction to determine program effectiveness. Educates patients regarding the disease process and medications, methods for improving medication compliance, available community resources and other pertinent information. Reviews medical records to identify needs and tracks outcomes.  Updates plans of care (ISP) as required and as needed. Performs reassessments as required by contractual/DOH HIV MCM Guideline requirements Utilizes the 104 day report to conduct outreach by phone and/or home visits to recapture and retain patients in care.   Assures all Department of Health (DOH) -HASTA jurisdiction MCM acuity driven client contacts targets are met and documented per HIV MCM Guidelines.  Assures all clients enrolled in the HIV MCM program meet RW DOH-HASTA eligibility criteria when services are delivered. Continually strives to meet the goals of the HIV MCM program when working with clients: •    Taking all medications as prescribed •    Making and keeping of medical and case management appointments •    Addressing barriers to care and treatment •    Adapting to therapeutic lifestyle changes as necessary   Collaborates with ASO’s and other community services in the Eligible Metropolitan Area (EMA), including specialty care providers, as necessary to ensure appropriate access to services and follow-up on the results to such referrals. Conducts home visits, when necessary to identify barriers and/or facilitate care management. Documents effectively in the computer system and tracks outcomes of care on an individual and aggregate basis regarding the patient and provider population. Updates CareWare information as appropriate. Updates the GAIN SS surveys per DOH and HASTA requirements Enters all documentation of activities in the computer system within 48 hours of performance of said activities. Conduct training for other associates regarding the overall Case Management Program and specific processes such as the case management referral process. Maintains detailed record of time spent providing service to each patient and submits this information at regular intervals for timely billing. Monitors patient’s acuity level in an ongoing fashion to ensure disenrollment when patient is no longer an acuity level that  necessitates case management, In DC monitor the Acuity Tool and establishes Clients needs from the Acuity Score, and follows patient accordingly.  Provides feedback to the referring provider regarding planned disenrollment from program. Participates in local EMA functions in the community and scheduled HASTA meetings. Participates and/or leads quality improvement activities as assigned. Assists in tracking, resolving and reporting of complaints/grievances. Maintains information in a confidential manner at all times. Supervises and monitors the duties and responsibilities assigned to the Medical Care Coordinator. Directs and monitors peer navigators activates to assist in returning members who have been lost to care Participation in AHF Meetings/Committees Monthly staff meeting Interdisciplinary Team meetings Quality Improvement meetings Grant Overview meetings Attends other meetings as required within AHF Attends County Meetings as they pertain to MCM in DC Attends Planning Council meetings Supervisory Responsibilities The RN MCM supervises the Medical Care Coordinator. As the RN Medical Case Manager, the RN MCM will oversee and monitor the assessments of the Medical Care Coordinator. The RN MCM will collaborate with the Medical Care Coordinator to ensure all reassessments have been conducted, all follow up phone calls are done on a timely manner and review all new patients with the Medical Care Coordinator as this is important for continuity of care and patient follow up.   Job Requirements: Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Requirements •    RN licensure and three (3) years clinical practice experience and practice case management within the scope of their licensure (based on the standards of the discipline). •    A Bachelors Degree in Nursing (preferred). •    Certification as a Case Manager within 12 months of employment  •    ACRN within 18 months of employment  Education Graduate of an accredited professional Nursing program, BSN Degree preferred.   Certificates, Licenses and/or Registrations Valid Washington DC Registered Nurse license  Certified in Case Management (CCM) within 12 months of employment AIDS Certified Registered Nurse within 18 months of employment Current CPR Certification Current driver’s license with proof of liability insurance. Experience •    3 or more years’ clinical experience in a health care environment. •    A minimum of one year experience working within HIV case management or relevant adult community health, clinical or hospital based environment.  Other Skills & Abilities/Qualifications:  •    Demonstrated ability for assessment, evaluation and interpretation of medical information.  •    Skilled in the operation of the computer including proficiency in Microsoft Office Word, Excel and Access.  •    Should have a high level of understanding of community resources, treatment options, home health availability, funding options and special programs. •    Preferred knowledge of HIV/AIDS and related issues as they relate to a diverse population. •    Bi-lingual preferred. •    Must be able to travel up to 25% of the time within the community to make personal visit to patient’s home, hospitals and/or healthcare centers. Computer/Software Skills & Abilities To perform this job successfully, an individual should have knowledge of Word Processing software. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Mathematical Skills Intermediate Skills:  Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.  Ability to apply concepts of basic algebra and geometry. Reasoning Ability Ability to define problems, collect data, establish facts, and draw valid conclusions.  Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Overview: AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!   Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?   If so, AIDS Healthcare Foundation is the place for you!   Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.    AHF’s core values are:   • Patient-Centered • Value Employees • Respect for Diversity • Nimble • Fight for What’s Right   STILL INTERESTED? Please continue!   Responsibilities: Summary: The Integrated Medication Management RN Care Manager is responsible for projecting and integrating the Mission and Core Values of the organization in the provision care management services to members of the AHF Medicare and Medicaid health plans of California.   Key responsibilities include performing a timely (minimum yearly) assessment and care plan, including a Comprehensive Medication Review (CMR) and Targeted Medication Review (TMR) in collaboration with the Pharmacist. The IMM program is composed of a team including the Pharmacist, Tech and RN and is focused on those patients who receive medications from the AHF pharmacy, but do not use AHF Healthcare Centers. Through the nursing assessment, the RN will provide Disease Management of HIV/AIDS and any other co-morbidity as indicated by medications filled by the AHF pharmacy. The RN will work closely with the Pharmacist to identify appropriate interventions as a result of the assessment and CMR.   Essential Duties & Responsibilities Duties and Responsibilities include but are not limited to: Collaborates with the IMM team to ensure patients are well supported in the management of their medication and diagnosis. Collaborates with Pharmacist so that appropriate interventions, education and ongoing dialogue are maintained. Responsible to manage and coordinate care as it related to Medication Management, Individual Care Plans and Nursing Assessment for an assigned population of pharmacy patients. This includes but are not limited to high utilization members, members classified as polypharmacy, Completes assessments, re-assessments and care coordination for patients as assigned within the designated time lines. With the patient, establishes patient centered long term and short term goals for care and management of the member’s disease state. With the input of the patient, family and IMM team creates an appropriate and timely individual care plan to assist the member to achieve the established goals Communicates the care plan to the patient and IMM team and monitors for success Revises the Care Plan to reflect changes in the member’s health and needs, at a minimum following hospitalization of the member, or following the annual re-assessment. Meets with patients in all care settings to complete assessments and other contacts, as necessary. Monitors the appropriate use of outpatient ancillary services, medication adherence, compliance to PCP visit schedules and results of lab work. Provides support to patient in the form of calls, follow-up visits, collaboration with providers and family in all care settings. Provides health education regarding disease process, medications, medication adherence, community resources and benefits. Maintains current clinical knowledge of HIV/AIDS medications and treatment regimens.   Qualifications: Education and/or Experience Graduate from an accredited RN program required Advanced Nursing Degree preferred At least five years clinical experience and three years Case Management, Community nursing, Home Health or Hospice nursing desired Certified Case Manager (CCM) or eligible for certification with one year of employment. Experience in field case management, including working remotely from a pharmacy, home office or field station.   Travel: Over 50% Local travel. This position will work between a remote home/ field based location and the pharmacy assigned. Local travel to AHF pharmacy, patient homes when indicated and telephonic communication is expected. The IMM RN will also travel to AHF Corporate or Regional offices when appropriate.     Certificates, Licenses and Registrations Unrestricted Registered Nurse licensed by the State of Florida Advanced Nursing/ Baccalaureate Degree preferred Certification in case management preferred Valid Florida Driver’s License with proof of automobile liability insurance   We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability.  The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment.   #LI-HT1

Responsibilities: Includes the following.  Other duties may be assigned. Responsible for the direction of Utilization and Case Management Departments; Maintains adequate functionality and effective administration of departments; Coordinates staff schedules to assure effective functioning of programs. Implements and evaluates Utilization Management and Case Management policies and procedures, guidelines and action plans in compliance with all state/federal and/or Medicare/Medicaid requirements. Monitors and evaluates the performance of Case Management and Utilization Programs through activity reports to assure appropriate delivery of health care services and adherence to regulatory and contractual requirements; ensures that the Utilization Management and Case Management Programs are compliant with state/federal and/or Medicare/Medicaid specifications for Managed Care Programs. Participates in the development, implementation, and oversight of specialty programs and/or expense programs; Analyzes performance of programs against AHF MCO goals, industry standards and contractual performance guarantees. Conducts utilization and site audits required to meet regulatory and contractual obligations. Forecasts and develops plans for departmental allocation of resources; Assists in the development of departmental budgets; Maintains budget; Prepares monthly variance reports with corrective actions. Develops, monitors and analyzes key program indicators in the areas of utilization and quality; Takes corrective action as necessary. Coordinates lines of communication between Utilization and Case Management staff, Disease Management and Executive Management. Participates in provider relations and contracting activities as necessary to maintain and develop AHF MCO Contracted Provider Networks. Administers Utilization Management Referral, Prior Authorization, grievance and appeal processes, working closely with the Plan Medical Director to ensure compliance to AHF MCO timeframes for action and notification. Coordinates Utilization Management and Case Management Committee agenda; Provides quality indicator reports and report analysis to committee members and Executive Management. Provides administrative clinical oversight to Medical Claims Department and works with them to maintain clear lines of communication and effective processes for prospective, concurrent and retrospective review of services provided and paid.  Participation in AHF Meetings/Committees Attends AHF MCO meetings as assigned. Attends Utilization Management and Case Management Committee Meetings. Chairs Committees as assigned. Supervisory Responsibilities Carries out supervisory responsibilities in accordance with AHF MCO policies and applicable laws.  Responsibilities include interviewing, hiring, and training employees;  planning, assigning and directing work, appraising performance;  rewarding and disciplining employees;  addressing complaints and resolving problems.    Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.    The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience Graduate from an accredited RN Program with 3 or more years of recent medical/surgical or HIV/AIDS nursing experience and 3 or more years of recent Utilization Review/Case Management experience. Computer/Software Skills & Abilities To perform this job successfully, an individual should have knowledge of Contact Management systems, Word processing software, and Spreadsheet software. Language Skills Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.  Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.  Ability to write speeches and articles for publication that conform to prescribed style and format.  Ability to effectively present information to top management, public groups, and/or boards of directors. Mathematical Skills High Skills:  Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.  Ability to apply concepts such as fractions, percentages, rations, and proportions to practical solutions. Reasoning Ability Very High Skills:  Ability to define problems, collect data, establish facts, and draw valid conclusions.  Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables Other Skills & Abilities/Qualifications Ability to successfully work with various levels of professional staff Must be able to work independently and as part of a team. Knowledge of HIV/AIDS and related medical and patient care issues and concerns in diverse populations. Certificates, Licenses and Registrations Current Florida RN License     DISCLAIMER: We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment.   Req No  2016-4446