Find The Best Clinical Case Manager Jobs For You

Where do you want to work?

0 selections

Clinical Case Manager - Utilization Review

HCA
Dulles Town Center, VA
SCHEDULE: Part-time

Located outside of Washington, DC in the historic Loudoun County, StoneSprings Hospital Center, a 124- bed acute care facility, lies in an area full of attractions including historic parks, horseback riding, dining, shopping, and more! StoneSprings Hospital Center is a Hospital Corporation of America (HCA) facility, which is one of the largest healthcare systems throughout the U.S where healthcare opportunities are almost unlimited!

StoneSprings Hospital Center has earned The Joint Commission's Gold Seal of Approval and holds accreditation from the Joint Commission. Most importantly, we are dedicated to enhancing the health and quality of life in our community by putting patients first.

We are launching our psychiatric services this October and seeking a Clinical Case Managerwho share our passion for mental health! Our new behavioral health unit will be an opportunity for you to be a part of a new and growing project, where you will have a voice and opportunity to make impacts on day to day patient experiences. The 17 bed unit will open, October 2021.

We believe in our team and your ability to do excellent work with us. We offer you an extensive total compensation and benefits package. In addition to job security and the reputability that comes with HCA, your benefits will include a competitive salary, 401k with 3-9% matching, paid time off, extended FMLA, four medical plan options, dental, flex spending, life, disability, employee discount programs, employee stock purchase program, tuition reimbursement and student loan repayment, and more.

We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status
Qualifications

Part-time

* One Year paid employment or a field placement in a health care setting.
* Bachelor Degree in Social Work or Human Service field - OR - Employees hired prior to June 1, 2010 - minimum 10 years Case Management experience in lieu of educational degree.
* RN with valid Virginia license. Master of Social Work Degree from an accredited school of Social Work.

Notice

Our Company's recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here.

For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.

Apply
60d+ ago

Clinical Case Manager - Utilization Review

HCA, Hospital Corporation of America
Dulles Town Center, VA
Located outside of Washington, DC in the historic Loudoun County, StoneSprings Hospital Center, a 124- bed acute care facility, lies in an area full of attractions including historic parks, horseback riding, dining, shopping, and more! StoneSprings Hospital Center is a Hospital Corporation of America (HCA) facility, which is one of the largest healthcare systems throughout the U.S where healthcare opportunities are almost unlimited!

StoneSprings Hospital Center has earned The Joint Commission's Gold Seal of Approval and holds accreditation from the Joint Commission. Most importantly, we are dedicated to enhancing the health and quality of life in our community by putting patients first.

We are launching our psychiatric services this October and seeking a Clinical Case Managerwho share our passion for mental health! Our new behavioral health unit will be an opportunity for you to be a part of a new and growing project, where you will have a voice and opportunity to make impacts on day to day patient experiences. The 17 bed unit will open, October 2021.

We believe in our team and your ability to do excellent work with us. We offer you an extensive total compensation and benefits package. In addition to job security and the reputability that comes with HCA, your benefits will include a competitive salary, 401k with 3-9% matching, paid time off, *extended FMLA*, four medical plan options, dental, flex spending, life, disability, employee discount programs, employee stock purchase program, *tuition reimbursement and student loan repayment, and more.*

/We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status/

*Part-time *
*One Year paid employment or a field placement in a health care setting.

*Bachelor Degree in Social Work or Human Service field - OR - Employees hired prior to June 1, 2010 - minimum 10 years Case Management experience in lieu of educational degree.

*RN with valid Virginia license. Master of Social Work Degree from an accredited school of Social Work.

**Job:** **Case Management*

**Title:** *Clinical Case Manager - Utilization Review*

**Location:** *Virginia-Dulles-Stone Springs Hospital Center*

**Requisition ID:** *26630-22138*
60d+ ago

Clinical Case Manager- RN

Aveanna
Burke, VA
Job Ref:

120265

Location:

Burke, VA 22009

Category:

Nursing

Line of Business:

PDN

ApplyRefer a FriendBack

Our care is greatin a crisis At Aveanna, the largest pediatric home healthcare company, you can work with one patient in one home. It's simply a safer place to care. Meanwhile, your work as a Registered Nurse (RN) helps to keep our medically fragile patients out of the hospital so ER nurses can devote their efforts to COVID-19 patients. In other words, it's a job that matters now more than ever.

Caring In Action

RN Responsibilities Include:

+ Execution of physician's prescribed plan of care and compliant documentation of care in system of record.

+ Administration of prescribed medication, treatments, and therapies.

+ Patient assessments and coordination of care.

+ Health, promotion, teaching, and training of family members.

RN Requirements for Success

+ Must have eligible good-standing license (RN) for the state in which the clinician will practice.

+ Current CPR certification

+ Must be comfortable providing in-home nursing care to infants, children, adolescents, and adults

+ Pediatrics experience is helpful, but not necessary. We offer exceptional training for all nurses.

Why More Nurses Are SayingYESto Aveanna

+ Local/community cases allow us to match you to a case that's close to home

+ 1-on-1 Personalized Care

+ 24/7 clinical and operational support for direct clinical, plus scheduling assistance

+ Competitive Weekly Pay

+ State-of-the-art technology allowing electronic charting at point of care

+ Flexible shifts and scheduling (8, 12, or 16-hour shifts; days/nights/weekends available)

+ Full-time and salaried career opportunities

"Aveanna means family! It's a dedicated team of caregivers and office staff providing compassionate and exceptionally proficient care to medically fragile children on a level above and beyond anything I have experienced in my 30 years of nursing!"- Meg, RN

Wellness

+ Health, Dental, Vision, and Life Insurance*

+ Paid Time Off Available*

+ 401(k) Savings Plan with Employer Matching*

+ Paid training and ongoing professional development

+ Referral Bonuses

+ Nationwide footprint offers advancement and development opportunities

*Benefit eligibility is dependent on employment status

Our MissionAveanna Healthcare is one of the nation's leading providers of pediatric and adult homecare in the nation. We lead with clinical quality and compassion, delivering care in over 200 locations in 23 states. While we have a national presence, we are very much a local provider in each community we serve. Our stated mission is to revolutionize the way pediatric healthcare is delivered, one patient at a time, and we hope you will help us fulfill that mission by joining the 30,000 nurses who already call Aveanna home. Apply today.
22d ago

Clinical Case Manager - Virtual - PSH VIRTUAL HEALTH

Penn State Health
Remote or Hershey, PA
Penn State Health Shared Services

Location: US:PA:Hershey

Work Type: Full Time

FTE: 1.00

Shift: Varied Hours: 7:00a - 3:00p OR 9:00a - 5:00p

Recruiter Contact: Amy Hazel at ahazel@pennstatehealth.psu.edu

JOB SUMMARY:

Responsible to coordinate interdisciplinary professional care of a select patient population as determined by individualized plan of care, clinical pathways, managed care guidelines and contracts. Mobilizes resources and manages the systems to respond to concurrent and respective data analysis, identifying variances. Participates in developing programs to improve clinical quality and fiscal outcomes, maintains knowledge of and responds to clinical system and fiscal data related to specific patient populations.

MINIMUM QUALIFICATIONS:

Bachelor's degree in Nursing or Master's degree in Nursing required

3 years clinical experience in specialty area required

Currently licensed to practice as a registered nurse by Pennsylvania Board of Nurse Examiners required

KNOWLEDGE, SKILLS, & ABILITIES:

Strong communications skills both oral and written required

Strong organizational skills required

Ability to analyze data reports on patient outcomes required

PREFERRED QUALIFICATIONS:

Experience as a case manager, in discharge planning or insurance issues preferred

Appropriate certification for specialty area preferred

Proficiency in Microsoft Office preferred

Motivational interviewing skills preferred

This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.

Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person's perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information. If you are unable to use our online application process due to an impairment or disability, please call 717-531-8440 between the hours of 8:30 AM and 4:30 PM, Eastern Standard Time, Monday - Friday, email hrsolutions@pennstatehealth.psu.edu or download our Accommodation Instructions for Job Applicants PDF (https://cdn-static.findly.com/wp-content/uploads/sites/595/2018/05/Accommodation-Request-Updated-04.27.18.pdf) for more detailed steps for assistance.

Position Clinical Case Manager - Virtual - PSH VIRTUAL HEALTHLocation US:PA:HersheyReq ID 1233
New
Easy Apply
4d ago

Clinical Case Manager BH

CVS Health
Remote or Overland Park, KS
Fully remote position.Must be willing to travel up to 50%Schedule Monday-Friday, 8am-5pm.No weekends or holidays are required. Candidates have to live in Kansas to be considered for this role. Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.Assessment of Members: Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and availableinternal and external programs/services. - Applies clinical judgment
Required Qualifications

3 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic and/or facility- Case management and discharge planning experience- Unencumbered Behavioral Health clinical state license required (LMSW, LSCSW, LMLP, LPC, LCPC, LMFT, LCMFT or related behavioral health licensure)

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

+ If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

+ If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

-Crisis Intervention skills preferred-Managed Care experience preferred-Hospital experience preferred-Experience with youth and behavioral health

Education

Minimum of a Master's degree in Behavioral/Mental Health or related field required.

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
New
3d ago

Clinical Case Manager BH

Aetna Inc.
Remote or Overland Park, KS
Fully remote position.

Must be willing to travel up to 50%

Schedule Monday-Friday, 8am-5pm.

No weekends or holidays are required.

Candidates have to live in Kansas to be considered for this role.

Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.

Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.

Assessment of Members: Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available

internal and external programs/services. - Applies clinical judgment

Required Qualifications

3 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic and/or facility

* Case management and discharge planning experience
* Unencumbered Behavioral Health clinical state license required (LMSW, LSCSW, LMLP, LPC, LCPC, LMFT, LCMFT or related behavioral health licensure)

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

* If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
* If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

* Crisis Intervention skills preferred
* Managed Care experience preferred
* Hospital experience preferred
* Experience with youth and behavioral health

Education

Minimum of a Master's degree in Behavioral/Mental Health or related field required.

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
New
4d ago

Clinical Case Manager, RN - Telecommute in TN

Unitedhealth Group Inc.
Remote or Brentwood, TN
UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) Case Manager will manage people enrolled in FIDE SNP, who receive Long Term Services and Supports (LTSS), in their assigned counties telephonically, and may be required to travel at times to meetings, meet and greets, and infrequent field visits. The FIDE SNP Case Manager will complete health assessments, post hospital assessments, care coordination, and case management telephonically. Other responsibilities of the FIDE SNP Case Manager will include assisting with discharge planning, clinical and medical management of home services, monitoring interventions and clinical education. Work is generally fast paced, self-directed and not prescribed; critical thinking skills are essential.

If you live in Tennessee, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities:

* Assess, plan and implement care strategies that are individualized and directed toward the most appropriate, least restrictive setting
* Collaborate with FIDE SNP person, family, and healthcare providers to develop, modify, and update Individualized Care Plans (ICP) inclusive of measurable goals and outcomes
* Engage assigned individuals telephonically to coordinate services, community resources, and treatment needs
* Facilitate/lead Interdisciplinary Care Team (ICT) meetings and communicate information to assist with safe transitions of care
* Function as an advocate for assigned individuals assisting to decrease unnecessary hospitalizations and emergency room visits
* Deliver a holistic approach to coordinated care based on the person's needs
* Identify early risk factors and conduct ongoing evaluations, to maintain a dynamic individualized care plan reflecting changing needs
* in an electronic file
* Communicate with the ICT including, the person served, family, and or caregiver, to ensure quality coordinated care and services are provided expeditiously
* Create, review and revise ICP, focusing on medical management and education to improve the person's self-management skills
* Collaborate with the person's Primary Care Provider (PCP) to deliver and coordinate necessary services
* Build relationships with individuals and their families; consulting on health decisions when appropriate
* Ensure timely documentation

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

* Current, unrestricted RN license in the State of Tennessee
* 3+ years of clinical experience
* 2+ years of home care/home health and/or other case management experience
* Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
* Demonstrated problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
* Demonstrated ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
* Reliable transportation

Preferred Qualifications:

* Bachelor's Degree in Nursing
* Certification in Case Management (CCM)
* Medicaid experience
* Medicare experience
* Experience managing chronic and/or complex medical conditions
* Experience working in a health plan or other managed care setting
* Experience with community health and/or public health
* Experience with LTSS
* Experience working with electronic medical records (EMR) systems

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status

Full COVID-19 vaccination is an essential function of this role. UnitedHealth Group will adhere to all federal, state, and local regulations- as well as all client requirements and will obtain the necessary information from new hires prior to employment to ensure compliance. You will be expected to perform all essential functions of this role with or without reasonable accommodation. Failure to meet this requirement may result in the rescission of your offer or the termination of your employment.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

* All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: TN, Telecommute, Telecommuter, Telecommuting, Remote, Work from home, RN, registered nurse, Medicaid, Medicare, TN counties, Tennessee, CCM, certified case manager, home health, hospice, home care, case management, case manager, UnitedHealth Group
19d ago

Clinical Case Manager, RN - Telecommute in TN

Unitedhealth Group
Remote or Brentwood, TN
UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing **your life's best work.(sm)**

The Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) Case Manager will manage people enrolled in FIDE SNP, who receive Long Term Services and Supports (LTSS), in their assigned counties telephonically, and may be required to travel at times to meetings, meet and greets, and infrequent field visits. The FIDE SNP Case Manager will complete health assessments, post hospital assessments, care coordination, and case management telephonically. Other responsibilities of the FIDE SNP Case Manager will include assisting with discharge planning, clinical and medical management of home services, monitoring interventions and clinical education. Work is generally fast paced, self-directed and not prescribed; critical thinking skills are essential.

If you live in Tennessee, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.
**Primary Responsibilities:**

+ Assess, plan and implement care strategies that are individualized and directed toward the most appropriate, least restrictive setting

+ Collaborate with FIDE SNP person, family, and healthcare providers to develop, modify, and update Individualized Care Plans (ICP) inclusive of measurable goals and outcomes

+ Engage assigned individuals telephonically to coordinate services, community resources, and treatment needs

+ Facilitate/lead Interdisciplinary Care Team (ICT) meetings and communicate information to assist with safe transitions of care

+ Function as an advocate for assigned individuals assisting to decrease unnecessary hospitalizations and emergency room visits

+ Deliver a holistic approach to coordinated care based on the person's needs

+ Identify early risk factors and conduct ongoing evaluations, to maintain a dynamic individualized care plan reflecting changing needs

+ in an electronic file

+ Communicate with the ICT including, the person served, family, and or caregiver, to ensure quality coordinated care and services are provided expeditiously

+ Create, review and revise ICP, focusing on medical management and education to improve the person's self-management skills

+ Collaborate with the person's Primary Care Provider (PCP) to deliver and coordinate necessary services

+ Build relationships with individuals and their families; consulting on health decisions when appropriate

+ Ensure timely documentation

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

**Required Qualifications:**

+ Current, unrestricted RN license in the State of Tennessee

+ 3+ years of clinical experience

+ 2+ years of home care/home health and/or other case management experience

+ Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications

+ Demonstrated problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

+ Demonstrated ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

+ Reliable transportation

**Preferred Qualifications:**

+ Bachelor's Degree in Nursing

+ Certification in Case Management (CCM)

+ Medicaid experience

+ Medicare experience

+ Experience managing chronic and/or complex medical conditions

+ Experience working in a health plan or other managed care setting

+ Experience with community health and/or public health

+ Experience with LTSS

+ Experience working with electronic medical records (EMR) systems

_UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status_

_Full COVID-19 vaccination is an essential function of this role. UnitedHealth Group will adhere to all federal, state, and local regulations- as well as all client requirements and will obtain the necessary information from new hires prior to employment to ensure compliance. You will be expected to perform all essential functions of this role with or without reasonable accommodation. Failure to meet this requirement may result in the rescission of your offer or the termination of your employment._

**Careers at UnitedHealthcare Community & State.** Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do **your life's best work.(** **sm** **)**

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

_Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._

_UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

Job Keywords: TN, Telecommute, Telecommuter, Telecommuting, Remote, Work from home, RN, registered nurse, Medicaid, Medicare, TN counties, Tennessee, CCM, certified case manager, home health, hospice, home care, case management, case manager, UnitedHealth Group
42d ago

Clinical Case Manager Utilization Review

Medstar Health
Washington, DC
Monitors the care and services delivered to selected patient populations during the acute hospital stay, promotes effective utilization of resources and assumes a leadership role with the interdisciplinary team to achieve optimal clinical and resource outcomes for the prehospital, acute, and post hospital phases of care. Develops and maintains a positive work climate and supports the overall team effort of the health system. The functions are performed in accordance with all applicable laws and regulations and MedStar Georgetown University Hospital's philosophy, policies, procedures and standards.
Minimum Qualifications

Education/Training:Masters Degree in Social Work or Bachelor's Degree in Nursing required; Advanced Degree preferred.

Experience:Three years clinical experience in an acute care setting. Utilization management and/or case management experience preferred.

License/Certification/Registration:Licensed as a Nurse or Social Worker in the District of Columbia; Specialty certification desirable.

Knowledge, Skills & Abilities:Advanced communication and interpersonal skills. Demonstrated ability to manage information for the purpose of setting goals and measuring success. Willingness and ability to explain case management, managed care and reimbursement concepts and requirements to patients, families, and staff. Willingness and ability to coach colleagues and new staff in areas of professional expertise. Ability to determine when a referral to other departments is required by the patient'sclinical, social, or financial situation. Ability to interact with clinical departments as necessary to clarify components of the treatment or discharge plan. Ability to maintain effective communication with all members of the care team: patient, family, and hospital colleagues. Skill and proficiency in applying highly technical principles, concepts and techniques that are central to the health care professions.

Primary Duties and Responsibilities

* Assesses, facilitates, and monitors the plan of care in conjunction with the patient and/or family/significant other. Communicates the need, or lack of, continued hospitalization and ensures patient understanding of third party payer guidelines.

* Conducts concurrent chart review of selected patient populations, assesses the appropriateness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues, and completeness of medical record documentation.

* Reviews all patient admission data within the designated timeframes to determine the suitability of the level of care in accordance with established guidelines.

* Identifies issues/problems and makes appropriate recommendations. Communicates with patients, families/ significant others, medical staff, caregivers, and third party payers, as necessary.

* Coordinates care within MGUH and other settings by monitoring and overseeing the continuum of clinical care, ensuring necessary meetings are held with patient/family and the interdisciplinary team to coordinate treatment and discharge plans. Arranges discharge-planning referrals as ordered by patient's physician.

* Serves as a facilitator/advocate for patients and families in the resolution of problems related to the established plan of care and procurement of services.

* Monitors the daily activity of on-site reviewers for consistency and correctness in the application of standards for admission and continued stay.

* Produces case documentation in approved manual or electronic format while maintaining required departmental standards and protocols.

* Participates in the development and standardization of improved pathways and best practice scenarios.

* Assumes other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and is not to be considered as all-inclusive.

About MedStar Health

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.
New
4d ago

Clinical Case Manager Utilization Review

Medstar Research Institute
Washington, DC
Job Summary Monitors the care and services delivered to selected patient populations during the acute hospital stay, promotes effective utilization of resources and assumes a leadership role with the interdisciplinary team to achieve optimal clinical and resource outcomes for the prehospital, acute, and post hospital phases of care. Develops and maintains a positive work climate and supports the overall team effort of the health system. The functions are performed in accordance with all applicable laws and regulations and MedStar Georgetown University Hospital#s philosophy, policies, procedures and standards. Minimum Qualifications Education/Training:##Masters Degree in Social Work or Bachelor#s Degree in Nursing required; Advanced Degree preferred. Experience:##Three years clinical experience in an acute care setting. Utilization management and/or case management experience preferred. License/Certification/Registration:##Licensed as a Nurse or Social Worker in the District of Columbia; Specialty certification desirable. Knowledge, Skills # Abilities:##Advanced communication and interpersonal skills. Demonstrated ability to manage information for the purpose of setting goals and measuring success. Willingness and ability to explain case management, managed care and reimbursement concepts and requirements to patients, families, and staff. Willingness and ability to coach colleagues and new staff in areas of professional expertise. Ability to determine when a referral to other departments is required by the patient#s#clinical, social, or financial situation. Ability to interact with clinical departments as necessary to clarify components of the treatment or discharge plan. Ability to maintain effective communication with all members of the care team: patient, family, and hospital colleagues. Skill and proficiency in applying highly technical principles, concepts and techniques that are central to the health care professions. Primary Duties and Responsibilities Assesses, facilitates, and monitors the plan of care in conjunction with the patient and/or family/significant other. Communicates the need, or lack of, continued hospitalization and ensures patient understanding of third party payer guidelines.# Conducts concurrent chart review of selected patient populations, assesses the appropriateness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues, and completeness of medical record documentation.# Reviews all patient admission data within the designated timeframes to determine the suitability of the level of care in accordance with established guidelines.# Identifies issues/problems and makes appropriate recommendations. Communicates with patients, families/ significant others, medical staff, caregivers, and third party payers, as necessary.# Coordinates care within MGUH and other settings by monitoring and overseeing the continuum of clinical care, ensuring necessary meetings are held with patient/family and the interdisciplinary team to coordinate treatment and discharge plans. Arranges discharge-planning referrals as ordered by patient#s physician. # Serves as a facilitator/advocate for patients and families in the resolution of problems related to the established plan of care and procurement of services.# # Monitors the daily activity of on-site reviewers for consistency and correctness in the application of standards for admission and continued stay.# Produces case documentation in approved manual or electronic format while maintaining required departmental standards and protocols.# Participates in the development and standardization of improved pathways and best practice scenarios.# Assumes other duties and responsibilities that are appropriate to the position and area.# The above responsibilities are a general description of the level and nature of the work assigned to this classification and is not to be considered as all-inclusive.#

* Monitors the care and services delivered to selected patient populations during the acute hospital stay, promotes effective utilization of resources and assumes a leadership role with the interdisciplinary team to achieve optimal clinical and resource outcomes for the prehospital, acute, and posthospital phases of care. Develops and maintains a positive work climate and supports the overall team effort of the health system. The functions are performed in accordance with all applicable laws and regulations and MedStar Georgetown University Hospital's philosophy, policies, procedures and standards.
* Minimum Qualifications
* CONSIDERATION WILL BE GIVEN TO AN APPROPRIATE COMBINATION OF EDUCATION/TRAINING AND EXPERIENCE.

*
* Education/Training
* Masters Degree in Social Work or Bachelor s Degree in Nursing required; Advanced Degree preferred.

*
* Experience
* Three years clinical experience in an acute care setting. Utilization management and/or case management experience preferred.

*
* License/Certification/Registration
* Licensed as a Nurse or Social Worker in the District of Columbia; Specialty certification desirable.

*
* Knowledge, Skills & Abilities
* Advanced communication and interpersonal skills. Demonstrated ability to manage information for the purpose of setting goals and measuring success. Willingness and ability to explain case management, managed care and reimbursement concepts and requirements to patients, families, and staff. Willingness and ability to coach colleagues and new staff in areas of professional expertise. Ability to determine when a referral to other departments is required by the patient?s clinical, social, or financial situation. Ability to interact with clinical departments as necessary to clarify components of the treatment or discharge plan. Ability to maintain effective communication with all members of the care team: patient, family, and hospital colleagues. Skill and proficiency in applying highly technical principles, concepts and techniques that are central to the health care professions.

* Primary Duties and Responsibilities
* Assesses, facilitates, and monitors the plan of care in conjunction with the patient and/or family/significant other. Communicates the need, or lack of, continued hospitalization and ensures patient understanding of third party payer guidelines.

* Conducts concurrent chart review of selected patient populations, assesses the appropriateness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues, and completeness of medical record documentation.

* Reviews all patient admission data within the designated timeframes to determine the suitability of the level of care in accordance with established guidelines.

* Identifies issues/problems and makes appropriate recommendations. Communicates with patients, families/ significant others, medical staff, caregivers, and third party payers, as necessary.

* Coordinates care within MGUH and other settings by monitoring and overseeing the continuum of clinical care, ensuring necessary meetings are held with patient/family and the interdisciplinary team to coordinate treatment and discharge plans. Arranges discharge-planning referrals as ordered by patient s physician.

* Serves as a facilitator/advocate for patients and families in the resolution of problems related to the established plan of care and procurement of services.

* Monitors the daily activity of on-site reviewers for consistency and correctness in the application of standards for admission and continued stay.

* Produces case documentation in approved manual or electronic format while maintaining required departmental standards and protocols.

* Participates in the development and standardization of improved pathways and best practice scenarios.

* Assumes other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and is not to be considered as all-inclusive.
New
3d ago

Clinical Case Manager

Friendship Place
Washington, DC
60d+ ago

Clinical Case Manager BH

CVS Health
Remote or Overland Park, KS
New
3d ago

Clinical Case Manager - Behavioral Health

CVS Health
Remote or Orlando, FL
New
4d ago

Clinical Case Manager - Behavioral Health

CVS Health
Remote or Orlando, FL
New
3d ago

Clinical Case Manager - Behavioral Health

Aetna Inc.
Remote or Cleveland, OH
New
3d ago

Clinical Case Manager - Behavioral Health

Aetna Inc.
Remote or Orlando, FL
New
5d ago

Clinical Case Manager Behavioral Health - LCSW or LCPC

CVS Health
Remote or Highland Park, IL
9d ago

Clinical Case Manager Behavioral Health - LCSW or LCPC

Aetna Inc.
Remote or Vernon Hills, IL
9d ago

Clinical Case Manager BH

Aetna Inc.
Remote or Spokane, WA
37d ago

Clinical Case Manager Behavioral Health

CVS Health
Remote or Tucson, AZ
56d ago

Clinical Case Manager Behavioral Health

CVS Health
Remote or Tucson, AZ
57d ago

Clinical Resources Management Case Manager

Medstar Health
Washington, DC
New
4d ago

Clinical Case Manager Behavioral Health - LCSW or LCPC

CVS Health
Remote or Highland Park, IL
60d+ ago

Clinical Case Manager BH LCSW or LCPC (Telework IL)

CVS Health
Remote or Buffalo Grove, IL
60d+ ago

Clinical Manager, Case Management - Washington, DC

Unitedhealth Group
Washington, DC
Opens new tabopen new tab
New
5d ago
Opens new tabopen new tab

Clinical Resource Management Case Manager

Medstar Health
Washington, DC
28d ago

Clinical Resources Management Case Manager

Medstar Research Institute
Washington, DC
38d ago

Clinical Case Manager Utilization Review

Medstar Research Institute
Washington, DC
33d ago

Clinical Resource Management Case Manager

Medstar Research Institute
Washington, DC
60d+ ago

Clinical Manager, Case Management - Washington, DC

Unitedhealth Group
Washington, DC
60d+ ago

Behavioral Health Case Manager Lead

Anthem, Inc.
Remote or Clearwater, FL
9d ago

After Hours Case Manager Lead Analyst - 12% Shift Differential

Cigna
Remote
New
17h ago

Counselor/Case Manager

Lutheran Social Services of Illinois
Remote or Chicago, IL
23d ago

Lead Case Manager-Care Management

Trinity Health Corporation
Silver Spring, MD
31d ago

Case Manager/Support Group Leader (Adoption Promotion and Support Services)

Children's Bureau
Remote or Los Angeles, CA
60d+ ago

BH Case Manager I

Anthem, Inc.
Ashburn, VA
60d+ ago

Case Manager - Registered Nurse (RN) - Full Time for Home Health

Bayada Home Health Care
Cascades, VA
Opens new tabopen new tab
New
4d ago
Opens new tabopen new tab

Case Manager

Geo Group Inc.
Manassas, VA
10d ago

Case Manager

Catholic Charities USA
Arlington, VA
New
5d ago

Behavioral Case Mgr - Remote Available

Centene Corporation
Remote or San Antonio, TX
23d ago

Average Salary For a Clinical Case Manager

Based on recent jobs postings on Zippia, the average salary in the U.S. for a Clinical Case Manager is $45,211 per year or $22 per hour. The highest paying Clinical Case Manager jobs have a salary over $61,000 per year while the lowest paying Clinical Case Manager jobs pay $33,000 per year

Average Clinical Case Manager Salary
$45,000 yearly
$22 hourly
Updated October 24, 2021
33000
10 %
45000
Median
61000
90 %

Highest Paying Cities For Clinical Case Manager

0 selections
CityascdescAvg. salaryascdescHourly rateascdesc
San Francisco, CA
$60,323
$29.00
Farmington, CT
$58,074
$27.92
Evanston, IL
$49,534
$23.81
Athens, OH
$48,039
$23.10
Iowa City, IA
$47,724
$22.94
Seattle, WA
$45,901
$22.07

5 Common Career Paths For a Clinical Case Manager

Registered Nurse Case Manager

A registered nurse is responsible for providing medical services to patients, assisting doctors in hospitals, clinics, and other health centers. Registered nurses' duties include monitoring the condition of admitted patients, operating medical equipment, responding to patients' inquiries, assisting on physical exams and medications, keeping medical records, and observing strict hygienic standards. A registered nurse must display strong communication and organizational skills, as well as the ability to multi-task, attend to patients' needs, and adjust to different conditions.

Program Director

Program directors are employees who oversee all aspects of a specific program in the company. They usually work in nonprofit organizations or are assigned to a department doing corporate social responsibility activities. Program directors ensure that the program is in line with the company's goals. They also ensure that the resources assigned to the program are properly managed and that all finances are accounted for. They create strategies to ensure the success of the program and communicate these to everyone involved. They lead the implementation and evaluation of the program.

Supervisor

Supervisors are responsible for overseeing the daily functions of employees in a specific team, department, or even a work shift. They create work schedules, organize work processes and workflows, train new hires, provide necessary reports related to the team function and the employees, monitor and evaluate employee performance, and ensure that goals of the specific team or department are met. When needed, supervisors also provide guidance to employees in terms of their career or even personal challenges. They also help in fostering harmonious work relationships by resolving interpersonal conflicts at work. To be successful in their role, they must have leadership skills, time management skills, decision-making capabilities, analytical skills, and problem-solving skills.

Clinical Manager

A clinical manager is responsible for monitoring medical procedures and administrative duties to ensure the smooth flow of operations in a healthcare facility. Clinical managers manage the facility's staffing needs, evaluate budget reports, assist healthcare professionals on administering medical duties, and develop strategic procedures to optimize treatments and maximize productivity. A clinical manager enforces strict sanitary and safety regulations for everyone's strict compliance. They also need to have excellent knowledge of the medical industry to promote medical processes and provide the highest quality care.

Nursing Director

A nursing director's role is to oversee and evaluate all nurse staff in a hospital or organization, ensuring their efficiency at providing care towards patients. A nursing director's responsibilities mainly revolve around administrative tasks such as coordinating with physicians and other consultants, producing reports, conducting assessments, managing the budget and expenditures, and resolving issues. Furthermore, a nursing director must keep and maintain accurate records, ensuring all procedures adhere to the highest health standards and aligns with the hospital's policies and regulations.

Illustrated Career Paths For a Clinical Case Manager