- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** Case Manager RN will support our Medicare Population in the state of South Carolina. Case Manager will be required to communicate ... of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial… more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- …not limited to: + Provides consultation, training and support concerning the MA Medicaid, Medicare , Managed Care, and state case mix payment system for the ... Strong organizational skills and interpersonal skills + Demonstrated knowledge (Medicaid, Medicare ) and case management process (prior authorization and appeals)… more
- AmeriHealth Caritas (Newtown Square, PA)
- …RN or LCSW or BH equivalent advanced licensure. 5+ years of exp in case and utilization management Medicare program design and implementation. Your career starts ... **Corporate Director, Population Health Clinical Operations, Medicare ** Location: Newtown Square, PA Primary Job Function: Medical Management ID**: 37990 **Job… more
- Medical Mutual of Ohio (OH)
- …the state of Ohio. We are looking for applicants that have a strong clinical case management background. Medicare experience is a plus. Founded in 1934, Medical ... insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Under limited supervision,… more
- Genesis Healthcare (Rochester, NH)
- …MDS Nurse -- RN manages the overall process and tracking of all Medicare /Medicaid case -mix documents to ensure appropriate reimbursement for all services ... Medicare /Medicaid reimbursement, MDS completion, clinical resource utilization and/or case management is highly desirable. *Must maintain current BLS/CPR… more
- Molina Healthcare (Grand Island, NE)
- …Nebraska State plan. We are seeking a Registered Nurse with previous Case Management experience. Medicare knowledge/experience is highly preferred. Proficient ... organizational, and time management skills is highly preferred. The Case Manager must have the ability to work in...a high-volume environment to better serve our members. The Case Manager will conduct outreach calls to the members… more
- Henry Ford Health System (Clinton Township, MI)
- …of preventive service guidelines, clinical practice guidelines, behavior change theory, Medicare and Medicaid regulations and case management principles. ... PART TIME 20 HOURS DAY SHIFT GENERAL SUMMARY: The Case Manager is a member of the hospital or...and family's health care needs. The goals of the case manager are to promote patient safety, quality of… more
- Henry Ford Health System (Troy, MI)
- …of preventive service guidelines, clinical practice guidelines, behavior change theory, Medicare and Medicaid regulations and case management principles. + ... now hiring passionate & dedicated RN or Social Worker Case Managers to join a new Henry Ford Health...with some remote work day options. GENERAL SUMMARY: The Case Manager is an interdependent member of the patient-centered… more
- Henry Ford Health System (Clinton Township, MI)
- …of preventive service guidelines, clinical practice guidelines, behavior change theory, Medicare and Medicaid regulations and case management principles. . ... Under the direction of VP Operations, CNO, the Regional Director of Case Management is responsible for the development, implementation, and/or monitoring of the… more
- Molina Healthcare (Nampa, ID)
- …our Idaho State plan. We are seeking a Registered Nurse with previous Case Management experience. Medicare and Medicaid knowledge/experience is highly preferred. ... of MS Suite, strong organizational, and time management skills is highly preferred. The Case Manager must have the ability to work in a high-volume environment to… more
- Henry Ford Health System (Wyandotte, MI)
- …of preventive service guidelines, clinical practice guidelines, behavior change theory, Medicare and Medicaid regulations and case management principles. + ... 36 HOUR MIDNIGHTS GENERAL SUMMARY: The Integrated case Manager for Population Health is an interdependent...Knowledge of medical ethics and legal implications related to case management. Understanding of social determinants of health and… more
- Skyline Nursing Center (Dallas, TX)
- …government agencies. * Assigns, assists, and instructs staff in the RAI Process, PPS Medicare , Medicaid ( Case Mix as required) and clinical computer system in ... in a Skilled Nursing Facility preferred. * Excellent knowledge of Case -Mix, the Federal Medicare PPS process, and Medicaid reimbursement, as required. * Thorough… more
- Actalent (Los Angeles, CA)
- …The goal is to promote quality, cost-effective care. Requirements + CA RN license + Case Management experience + Medicare or Medical experience + Ability to work ... REMOTE RN Case Manager Hiring Now! Largest national Medicaid Managed...Managed Care Organization is looking for a REMOTE RN Case Manager to join their growing team! Opportunity to… more
- US Tech Solutions (RI)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information...improvement and customer service **Skills:** + Prior Authorization + Medicare and Medicaid + Call handling experience. **Education:** +… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** Utilizing multiple software systems to complete Medicare appeals case reviews Meeting or exceeding government mandated ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels… more
- Sunny Springs Nursing Center (Sulphur Springs, TX)
- …government agencies. * Assigns, assists, and instructs staff in the RAI Process, PPS Medicare , Medicaid ( Case Mix as required) and clinical computer system in ... in a Skilled Nursing Facility required. * Excellent knowledge of Case -Mix, the Federal Medicare PPS process, and Medicaid reimbursement, as required. * Thorough… more
- Katmai (Usaf Academy, CO)
- …and the Central Referral Center. + Maintains current directories of local Medicare providers, suppliers, and Institutions. + Evaluates case management process ... **SUMMARY:** Performs healthcare coordination and case management activities IAW Medical Treatment Facility (MTF) instructions. **ESSENTIAL DUTIES &… more
- Cambridge Health Alliance (Cambridge, MA)
- …effective and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case Manager will collaborate with ... RN Case Manager - Inpatient Case Management CH Apply Refer a Friend Back **Date Posted:** 11/06/2024 **Requisition Number:** 8614 **Location:** CHA Cambridge… more
- Priority Health Care (Marrero, LA)
- …+ Ensures submission of required paperwork in a timely manner (log sheets, case openings/closings, Medicaid/ Medicare forms, etc ) + Adheres to office protocol. ... SUMMARY: Reporting to the Social Services Lead the Intensive Housing Case Manager provides case management services to chronic homeless people in the community,… more