Case Manager jobs at Acuity Insurance

Licensed Behavioral Health Clinicians provide supportive counseling, advocacy, education, and care management to help patients and their families navigate mental illness, access community resources, and manage symptoms to help them remain safely inthe community This is a senior, master's level, licensed social services role that provides direct care as part of a team. Join us in building on our 130-year history and become a part of the Future of Care that is strengthening communities with high quality, integrated behavioral health programs.VNS Health Behavioral Health team members provide vital client-centered behavioral health care to New Yorkers most in need, across all stages of life and mental well-being. We deliver care wherever our clients are, including outpatient clinics, clients' homes, and the community. Our short- andlong-term service models include acute, transitional, and intensive care management programs that impact the most vulnerable populations, from children, to adolescents, to aging adults. As part of our fast-growing Behavioral Health team, you'll have an opportunity to develop and advance your skills, whether you're early in your career or an experienced professional. What We Provide Attractive sign-on bonus and referral bonus opportunities Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability Employer-matched retirement saving funds Personal and financial wellness programs Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care Generous tuition reimbursement for qualifying degrees Opportunities for professional growth and career advancement Internal mobility, CEU credits, and advancement opportunities Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals What You Will Do Utilizes approved assessments to identify clients/members needs and family needs; develops initial and ongoing clinical plan of care. Updates plan at specified intervals, and as needed based on changes in client/member condition or circumstances Performs and maintains effective care management for assigned caseload of clients/members. Leads the care coordination for complex psychiatric clinical cases. Tracks and monitors progress; maintains detailed, accurate and timely progress notes and other documentation Provides supportive counseling and/or supportive therapy as well as ongoing mental health services Collaborates and refers to appropriate agencies as required. Addresses any client/member concerns to ensure satisfaction with overall services provided and uses motivational interviewing techniques to foster behavioral changes Develops inventory of resources that meet the clients/members needs as identified in the assessment Provides linkage, coordination with, referral to and follow-up with appropriate service providers and managed care plans. Facilitates periodic case record reviews and case conferences with all providers serving the clients/members Provides information and assistance through advocacy and education to clients/members and family on availability and eligibility of entitlements and community services. Arranges transportation and accompanies clients/members to appointments as necessary Assists clients/members and/or families in the development of a sustainable network of community-based supports, utilizing identified strengths and tools designed to prevent future participant crises and/or reduce the negative impact if a crisis does occur Participates in initial and ongoing trainings as necessary to maintain and enhance clinical and professional skills Maintains updated case records in program EMR. Maintains case records in accordance with program policies/procedures, VNS Health standards and regulatory requirements Participates and consults with team supervisor in case conferences, staff meetings, utilization review and discharge planning meetings to determine if client/member requires an alternate level of care or is appropriate for discharge Participates in 24/7 on-call coverage schedule and performs on-call duties, as required Acts as liaison with other community agencies Provides short term counseling (coping skills, trauma informed, decision making) and Risk Health Assessment/Safety Planning Collects and reports data, as required while adhering to productivity standards Leads and participates in “Network Meetings” with client, client/ member's personal support network and other team members using the Open Dialogue Model Qualifications Master's Degree in Social Work, Psychology, Mental Health Counseling, Family Therapy or related degree Minimum of two years of mental health work experience providing direct services to clients/members with Serious Mental Illness (SMI), developmental disabilities, substance use disorders and/or chronic medical conditions required Effective oral/written/interpersonal communication skills required Bilingual skills may be required as determined by operational needs License and current registration to practice as a Mental Health Counselor, Marriage and Family Therapist , Social Worker, Clinical Social Worker or related license in New York State Valid NYS ID or NYS driver's license may be required as determined by operational needs. Pay Range USD $63,800.00 - USD $79,800.00 /Yr. About Us VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us - we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.

A leading health care organization located in Minneapolis is seeking an Associate General Counsel to oversee M&A legal functions. The ideal candidate should have a Juris Doctorate, at least 3 years of transactional experience, and strong skills in negotiation and stakeholder management. This position offers a competitive salary range of $132,200 to $226,600 annually along with a comprehensive benefits package. #J-18808-Ljbffr

• Great Work Life Balance! • Quarterly Bonus Opportunities! • Free CEU's for licenses and certificates • License and national certification reimbursement This is a work from home position requiring local field case management travel to cover the Seattle, WA region. RN degree required National Certification such as CCM, CRC, COHN, CRRC REQUIRED Prior Workers Compensation Case Management preferred To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management. Responsibilities Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem solving by appropriate use of research and resources. May perform other related duties as assigned. Qualifications Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. Minimum of 1-3 years diverse clinical experience and one of the below: Certification as a case manager from the URAC-approved list of certifications (required); A registered nurse (RN) license. Must be compliant with state requirements regarding national certifications. General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. Excellent analytical and customer service skills to facilitate the resolution of case management problems. Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes. Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees. Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes. Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously. Demonstrated leadership ability with a basic understanding of supervisory and management principles. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Must meet specific requirements to provide medical case management services. Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months. National certification must be obtained in order to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Must maintain a valid driver's license in state of residence. #LI-RG1

• Great Work Life Balance! • Quarterly Bonus Program! • Free CEU's for licenses and certificates • License and national certification reimbursement This is a work from home position requiring local field case management travel to cover the Orlando, FL region. RN degree required National Certification such as CCM, CRC, COHN, CRRC REQUIRED Prior Workers Compensation Case Management preferred To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management. Responsibilities Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem solving by appropriate use of research and resources. May perform other related duties as assigned. Qualifications Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. Minimum of 1-3 years diverse clinical experience and one of the below: Certification as a case manager from the URAC-approved list of certifications (preferred); A registered nurse (RN) license. Must be compliant with state requirements regarding national certifications. General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. Excellent analytical and customer service skills to facilitate the resolution of case management problems. Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes. Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees. Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes. Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously. Demonstrated leadership ability with a basic understanding of supervisory and management principles. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Must meet specific requirements to provide medical case management services. Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months. National certification must be obtained in order to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Must maintain a valid driver's license in state of residence. #LI-RG1

To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management. Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. Minimum of 1-3 years diverse clinical experience and one of the below: Certification as a case manager from the URAC-approved list of certifications (preferred); A registered nurse (RN) license. Must be compliant with state requirements regarding national certifications. General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. Excellent analytical and customer service skills to facilitate the resolution of case management problems. Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes. Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees. Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes. Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously. Demonstrated leadership ability with a basic understanding of supervisory and management principles. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Must meet specific requirements to provide medical case management services. Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months. National certification must be obtained in order to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Must maintain a valid driver's license in state of residence. #LI-RG1 Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem solving by appropriate use of research and resources. May perform other related duties as assigned.

To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management.

**SelectCommunity at BCBST is seeking a Registered Nurse** who is compassionate about case management, advocating for social, emotional, functional, mental, behavioral, and physical health of those who are intellectually and developmentally disabled\. In this role, the SelectCommunity Nurse Case Manager \(NCM\) assesses members' current status, facilitates coordination of long\-term services and supports under their insurance benefits and benefits under Department of Disability and Aging\. The SelectCommunity NCM collaborates with members, caregivers, conservators, and providers to develop individual, integrated plans of care based on health needs, while monitoring progress for members with multiple levels of acuity\. This role requires telephonic contacts and in person home visits with members on at least a monthly basis and as required by TennCare Contract\. SelectCommunity NCM is required to obtain Case Management certification within 2 years of being hired as a Case Manager\. SelectCommunity NCM is required to obtain certification in Developmental Disabilities Nursing within 3 years of being hired as a Case Manager\. _You will be a great match for this if you have an active RN license in the state of Tennessee, with 3 years of clinical experience, 5 years' experience in the healthcare field, and 2 years of experience with Intellectual and Developmental Disabilities\._ **Additionally, we're seeking a candidate who resides in Shelby County, TN, or in Tipton or Fayette counties, as travel is required to meet with members\.** **Job Responsibilities** + Supporting utilization management functions for more complex and non\-routine cases as needed\. + Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs\. + Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits + Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation\. + Digital positions must have the ability to effectively communicate via digital channels and offer technical support\. + Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions\. + Various immunizations and/or associated medical tests may be required for this position\. + This job requires digital literacy assessment\. **Job Qualifications** _License_ + Registered Nurse \(RN\) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law\. _Experience_ + 3 years \- Clinical experience required + 5 years \- Experience in the health care industry + For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required _Skills\\Certifications_ + Currently has a Certified Case Manager \(CCM\) credential or must obtain certification within 2 years of hire\. + For Select Community & Katie Beckett: In addition to CCM, Certification in Developmental Disabilities Nursing \(CDDN\) is required at hire, or must be attained within 3 years\. + Excellent oral and written communication skills + PC Skills required \(Basic Microsoft Office and E\-Mail\) Employees who are required to operate either a BCBST\-owned vehicle or a personal or rental vehicle for company business on a routine basis\* will be automatically enrolled into the BCBST Driver Safety Program\. The employee will also be required to adhere to the guidelines set forth through the program\. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the "Use of Non BCBST\-Owned Vehicle" Policy \(for employees driving personal or rental vehicles only\); and maintaining an acceptable motor vehicle record \(MVR\)\.\*The definition for "routine basis" is defined as daily, weekly or at regularly schedule times\. **Number of Openings Available** 1 **Worker Type:** Employee **Company:** VSHP Volunteer State Health Plan, Inc **Applying for this job indicates your acknowledgement and understanding of the following statements:** BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law\. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices \(****************************************************************** **BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity\. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via\-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered\. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means\.** As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945\. More than that, we're your neighbors and friends - fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow\. At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members\. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability\. We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously\. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST\. BCBST is a remote\-first organization with many employees working primarily from their homes\. Each position within the company is classified as either fully remote, partially remote, or office based\. BCBST hires employees for remote positions from across the U\.S\. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York\. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense\.If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance\.

To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management.

To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management. Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. Minimum of 1-3 years diverse clinical experience and one of the below: Certification as a case manager from the URAC-approved list of certifications (preferred); A registered nurse (RN) license. Must be compliant with state requirements regarding national certifications. General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. Excellent analytical and customer service skills to facilitate the resolution of case management problems. Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes. Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees. Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes. Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously. Demonstrated leadership ability with a basic understanding of supervisory and management principles. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Must meet specific requirements to provide medical case management services. Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months. National certification must be obtained in order to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Must maintain a valid driver's license in state of residence. #LI-RG1 Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem solving by appropriate use of research and resources. May perform other related duties as assigned.

To provide quality case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Quality Improvement Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability and Disability. Bachelor's Degree in a health-related field is preferred. Associates or diploma in nursing also accepted. Three years of Workers' Compensation case management with ability to independently coordinate a diverse caseload ranging in moderate to high complexity. Demonstrated ability to handle complex assignments and ability to work independently is required. Effective oral and written communication skills are required. Thorough understanding of jurisdictional WC statutes. Advanced knowledge to exert positive influence in all areas of case management. Advanced communications and interpersonal skills in order to conduct training, provide mentorship, and assist supervisor in general areas as assigned. Highly skilled at promoting all managed care products and services internally and externally. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Minimum of 1 nationally recognized Certification from the URAC list of approved certifications. Must be able to travel as required. Individuals who conduct initial clinical review possess an active, professional license or certification: To practice as a health professional in a state or territory of the U.S.; and With a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review. Must maintain a valid driver's license in state of residence. #LI-RG1 May assist supervisor/manager in review of reports, staff development. Reviews case records and reports, collects and analyzes data, evaluates client's medical and vocational status and defines needs and problems in order to provide proactive case management services. Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, quality assessment (QA) standards with a minimum of supervisory intervention. Facilitates a timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician and employer. Coordinates return to work with injured worker/disabled individual, employer and physicians. May recommend and facilitate completion of peer reviews and IME's by obtaining and delivering medical records and diagnostic films notifying patients. Manages cases of various product lines of at least 3-4 areas of service (W/C, Health, STD, LTD, Auto, Liability, TPA, Catastrophic, Life Care Planning). Specifically, the case manager should be experienced in catastrophic cases plus 2-3 additional types listed above. Renders opinions regarding case cost, treatment plan, outcome, and problem areas and makes recommendations to facilitate rehabilitation case management goals to include RTW. May review files for claims adjusters and supervisors. May perform job site evaluations/summaries. Prepares monthly written evaluation reports denoting case activity, progress and recommendations in accordance with state regulations and company standards. May obtain referrals from branch claims office or assist in fielding phone calls for management as needed. Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services. Maintains contact with all parties involved on case, necessary for rehabilitation of the client. May spend approximately 70% of work time traveling to homes, health care providers, job sites, and various offices as required to facilitate return to work and resolution of cases. May meet with employers to review active files. Reviews cases with supervisor monthly to evaluate file and obtain direction. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem resolution by appropriate use of research and resources. May perform other related duties as assigned.

To provide quality case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Quality Improvement Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability and Disability.

To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management. Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. Minimum of 1-3 years diverse clinical experience and one of the below: Certification as a case manager from the URAC-approved list of certifications (preferred); A registered nurse (RN) license. Must be compliant with state requirements regarding national certifications. General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. Excellent analytical and customer service skills to facilitate the resolution of case management problems. Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes. Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees. Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes. Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously. Demonstrated leadership ability with a basic understanding of supervisory and management principles. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Must meet specific requirements to provide medical case management services. Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months. National certification must be obtained in order to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Must maintain a valid driver's license in state of residence. #LI-KE1 Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem solving by appropriate use of research and resources. May perform other related duties as assigned.

To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management.

To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management. Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. Minimum of 1-3 years diverse clinical experience and one of the below: Certification as a case manager from the URAC-approved list of certifications (preferred); A registered nurse (RN) license. Must be compliant with state requirements regarding national certifications. General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. Excellent analytical and customer service skills to facilitate the resolution of case management problems. Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes. Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees. Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes. Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously. Demonstrated leadership ability with a basic understanding of supervisory and management principles. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Must meet specific requirements to provide medical case management services. Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months. National certification must be obtained in order to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Must maintain a valid driver's license in state of residence. #LI-RG1 Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem solving by appropriate use of research and resources. May perform other related duties as assigned.

✨Join a group of passionate advocates on our mission to improve the lives of youth! Rite of Passage Team is hiring for a Bilingual Case Manager at Canyon State Academy in Queen Creek, Arizona ✨ Canyon State Academy is located on a scenic 180-acre campus surrounded by Farm student housing for 300 + youth, a Thrift Store, Café, Barbershop and Church open to the community incorporating life skills for our students. Along with a fully equipped weight room, football stadium, an athletic center (gymnasium, padded wrestling room & more). Pay: $25.93 an hour $3,000 Sign on Bonus Perks & Benefits: Medical, Dental, Vision and company paid Life Insurance within 90 days, and 401k match of up to 6% after 1 year of employment, Paid Time Off that can be used as soon as it accrues and more! ROP-benefits-and-perks-2 What you will do: Case Manager is a member of the site team implementing the Rite of Passage program. The Case Manager is responsible for administrating, developing and facilitating the completion of case plans and treatment programs in accordance with the requests of the placing agency and the needs of each student on their caseload. Depending on location, the Case Manager reports to the Director of Student Services, Case Management Coordinator, Unit Manager and/or Program Director. To be considered you should: Possess a Bachelor's Degree in behavioral sciences, human services or social services field ~Bilingual in Spanish and English~ Child Welfare and/or case management experience ~ Be at least 21 years of age ~ Be able to pass a criminal background check, drug screen (we no longer test for THC), physical, and TB test ~ Be able to pass a search of the child abuse central registry. Schedule: Two Shifts Sunday to Thursday Tuesday to Saturday *Hours are based on the need of the program with one work from home day* *Schedule subject to change based on the need of the program* Apply today and Make a Difference in the Lives of Youth! After 40 years of improving the lives of youth, we are looking for passionate advocates to continue the legacy of helping young people become successful adults. As a Bilingual Case Manager, you will have the unique opportunity to create a positive, safe and supportive environment for the youth we serve while building a career rich in growth opportunities and self-fulfillment. Follow us on Social! Instagram / Facebook / Linkedin / Tik Tok / YouTube

Reporting to the Case Management Supervisor and/or their designee, the Non-Medical Case Manager is responsible for providing Non-Medical Case Management Services, that include EFA and Co-Morbidity Services and monitoring Ryan White eligibility. Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC's executive management, community organizers, the general public, THC's patients, physicians, colleagues, assigned staff, vendors, contractors and consultants for the purpose of providing and exchanging information. Example of Essential Job Functions Manages a caseload of patients Ensures all intake assessments are completed and assessments are reviewed semi-annually Ability to assess clients for needs related to treatment education, risk reduction and prevention. Responsible for all new patients are properly oriented to the unit (i.e. understand rules, policies, procedures, sign consent/release of information forms) Responsible for developing, implementing and evaluating individualized patient care plans Establishes long and short term goals for the patient which are S-M-A-R-T(Smart, Measurable, Achievable, Realistic, Timely) Ensure the patients are linked to care management and staff adhere to appropriate lines of communication that promote team based and patient centered care Ensure that advance preparations for patients are coordinated for providers and with patients. Participates in patient centered interdisciplinary care conferences and meetings as required. Acts as a liaison between patients, their families and healthcare providers Improve patients' quality of life through collaboration and follow up care Ensure customer service standards are continuously demonstrated. Facilitate collaboration between community health education resources and the patients Assist patients with creating, monitoring and documentation of self-management goals and follow up with patients regarding set goals, identify for needs assessment. Effectively tracks outcomes of care on an individual and aggregate basis regarding the patients Gathers and documents attempts to gather program eligibility information. Assist with navigation in patients' use of health center services Participates in professional development opportunities and attends staff/team meetings as deemed necessary Documents in medical record per policy and standards Provides in-service training, and on-the-job training to new staff within the scope of service Maintains information in a confidential manner in compliance with HIPAA and confidentiality policies and procedures. Performs other duties as assigned. Travel is required Minimum Education, Training and Experience Required AA Degree Required Bachelor's Level Degree preferred One year Case Management experience preferred

This is an RN position that specifically requires experience in STI, PrEP/PEP clinical care with an interest in supporting programmatic STI, PrEP/PEP services.

Reporting to the Case Management Supervisor and/or their designee, the Non-Medical Case Manager is responsible for providing Non-Medical Case Management Services, that include EFA and Co-Morbidity Services and monitoring Ryan White eligibility. Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC's executive management, community organizers, the general public, THC's patients, physicians, colleagues, assigned staff, vendors, contractors and consultants for the purpose of providing and exchanging information. Example of Essential Job Functions * Manages a caseload of patients * Ensures all intake assessments are completed and assessments are reviewed semi-annually * Ability to assess clients for needs related to treatment education, risk reduction and prevention. * Responsible for all new patients are properly oriented to the unit (i.e. understand rules, policies, procedures, sign consent/release of information forms) * Responsible for developing, implementing and evaluating individualized patient care plans * Establishes long and short term goals for the patient which are S-M-A-R-T(Smart, Measurable, Achievable, Realistic, Timely) * Ensure the patients are linked to care management and staff adhere to appropriate lines of communication that promote team based and patient centered care * Ensure that advance preparations for patients are coordinated for providers and with patients. * Participates in patient centered interdisciplinary care conferences and meetings as required. * Acts as a liaison between patients, their families and healthcare providers * Improve patients' quality of life through collaboration and follow up care * Ensure customer service standards are continuously demonstrated. * Facilitate collaboration between community health education resources and the patients * Assist patients with creating, monitoring and documentation of self-management goals and follow up with patients regarding set goals, identify for needs assessment. * Effectively tracks outcomes of care on an individual and aggregate basis regarding the patients * Gathers and documents attempts to gather program eligibility information. * Assist with navigation in patients' use of health center services * Participates in professional development opportunities and attends staff/team meetings as deemed necessary * Documents in medical record per policy and standards * Provides in-service training, and on-the-job training to new staff within the scope of service * Maintains information in a confidential manner in compliance with HIPAA and confidentiality policies and procedures. * Performs other duties as assigned. * Travel is required Minimum Education, Training and Experience Required * AA Degree Required * Bachelor's Level Degree preferred One year Case Management experience preferred

This is an RN position that specifically requires experience in STI, PrEP/PEP clinical care with an interest in supporting programmatic STI, PrEP/PEP services. Reporting to the Case Manager Supervisor and/or their designee, the Medical Case Manager is responsible for providing daily care coordination, case management, and direct patient care. This position works with HIV/AIDS and Hepatitis-C infected individuals. The incumbent will work as part of an interdisciplinary care team including, but not limited to, coordinating patient services such non- medical case management, mental health and substance abuse treatment and integration of primary medical and specialty care. This position provides health education for patients with an emphasis on medication adherence and treatment compliance. This position works as part of the Integrated Behavioral Health Case Management team. Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC's executive management, community organizers, the general public, THC's patients, physicians, colleagues, assigned staff, vendors, contractors and consultants for the purpose of providing and exchanging information. Example of Essential Job Functions * Manages a caseload of patients * Ensures all intake assessments are completed * Ability to assess clients for needs related to treatment education, risk reduction and prevention. * Responsible for All new patients and employees are properly oriented to the unit (i.e. understand rules, policies, procedures, sign consent/release of information forms) * Responsible for developing, implementing and evaluating individualized patient care plans * Establishes long and short term goals for the patient which are S-M-A-R-T(Smart, Measurable, Achievable, Realistic, Timely) * Educates patients regarding the disease process and medications, methods for improving medication compliance, available community resources and other pertinent information. * Ensure the patients are linked to care management and staff adhere to appropriate lines of communication regarding the work being done with patients * Directs and monitors team members in implementing patient's care plan. * Maintains extensive knowledge regarding the current standards of HIV/AIDS care and case management processes. * Ensure quality care is delivered in an efficient and effective manner. * Ensure customer service standards are continuously demonstrated. * Engaging patients and their care givers in understanding and setting self-management plans in a culturally and linguistically appropriate manner. * Facilitates and coordinates services to develop patient-centered, individualized, integrated patient care plans, including self-management and outcomes goals. * Collaborate with various health care providers across the care continuum to ensure that patients are effectively managed and that health care needs are met. * Ensure that advance preparations for patients are coordinated for providers and with patients. * Participates in patient centered interdisciplinary care conferences and meetings as required. * Responsible for care in collaboration with the patient's physician, the patient and/or family representative, and other members of the professional staff * Acts as a liaison between patients, their families and healthcare providers * Providing clinical expertise for assigned patient population * Reassessing all treatment plans according to policy and as needed * Improve patients' quality of life through collaboration and follow up care * Facilitate collaboration between community health education resources and the patients * Assist patients with creating, monitoring and documentation of self-management goals and follow up with patients regarding set goals * Communicates to other team members regarding the status of patients' social and mental health needs * Monitor patients' use of health center services and the adequateness and effectiveness of the services utilized, including patient flow * Develops and maintains policies and procedures as required * Participates in professional development opportunities and attends staff/team meetings as deemed necessary * Documents in medical record per policy and standards * Maintains accurate and up-to-date records in a timely manner * Provides in-service training, and on-the-job training to new staff within the scope of service * Assist with audits and quality issues * Provide services in clinic within the scope of services of license as directed by Supervisory staff. * Facilitates referrals to specialty care and support services * Follows up on all medical care related referrals and documents all contact and outcome in the medical record. * Interacts with providers, including specialists, to ensure comprehensive care for the patients * Disseminates information and educates the provider community and patients regarding the latest treatment protocols in HIV/AIDS management. * Collaborates with ASOs 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 * Effectively tracks outcomes of care on an individual and aggregate basis regarding the patients * Monitors patients acuity level in an ongoing fashion to ensure transition to reduced intensity of services when patient is no longer an acuity level that necessitates medical case management. * Communicates with all team members about changes to level of services * Maintains information in a confidential manner in compliance with HIPAA and confidentiality policies and procedures. * Participation in required Ryan White staff meetings * Clinical coverage for direct patient care when needed * Performs other duties as assigned within the scope of license. Required Knowledge, Skills and Abilities Knowledge of FQHC operations, operating principles, guidelines and bylaws. Excellent leadership, customer service, organizational and presentation skills as well as the ability to effectively communicate THC's vision, and motivate others to achieve it organizationally, departmentally, and personally/professionally. Ability to communicate effectively (verbally and in writing). Ability to plan and organize work initiatives to successfully accomplish center/organizational goals and objectives. Ability to multi-task, prioritize and delegate as appropriate. Strong analytical, problem solving and interpersonal skills. Ability to identify, develop and implement short/long-term strategic goals and objectives. Ability to develop and maintain customer relationships; influence, build credibility and trust. Ability to think critically as well as apply critical thinking skills. Ability to: ensure and advocate for quality healthcare and services; and, lead and manage a diverse staff. Must have demonstrated knowledge of HIV/AIDS services in Maryland, along with an interest and ability to expand knowledge through training. Knowledge of the federal 340B program and its requirements. Licenses and Certifications RN License