Medical case manager jobs near me - 460 jobs

The Telephonic Case Manager RN in Medical Oncology provides remote nursing support by coordinating patient care, educating members, and ensuring adherence to treatment plans. This role involves assessing patient health, identifying barriers, and connecting patients with necessary resources to improve health outcomes. Working primarily via telephone, the position requires strong clinical expertise, communication skills, and proficiency in healthcare technology systems. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today! The Telephonic Case Manager RN Medical/Oncology will identify, coordinate, and provide appropriate levels of care. The Telephonic Case Manager RN Medical/Oncology is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. This is a full-time, Monday - Friday, 8am-5pm position in your time zone. You'll enjoy the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Make outbound calls and receive inbound calls to assess members current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self-management Make referrals to outside sources Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. Solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes. 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 state of residence Active Compact RN License or ability to obtain upon hire 3+ years of experience in a hospital, acute care or direct care setting Proven ability to type and have the ability to navigate a Windows based environment Have access to high-speed internet (DSL or Cable) Dedicated work area established that is separated from other living areas and provides information privacy Preferred Qualifications BSN Certified Case Manager (CCM) 1+ years of experience within Medical/Oncology Case management experience Experience or exposure to discharge planning Experience in a telephonic role Background in managed care *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 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. Keywords: telephonic case management, oncology nurse, patient education, care coordination, medical management, healthcare advocacy, remote nursing, chronic disease management, UnitedHealth Group, RN license

We're unique. You should be, too. We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We're different than most primary care providers. We're rapidly expanding and we need great people to join our team. The Clinical Director will directly supervise and train primary care providers (PCPs) in his/her assigned center. The incumbent in this role is accountable for maximizing overall core model execution, including improving clinical quality, efficiency, outcomes, and clinician/patient satisfaction. In addition to being accountable for the overall clinical outcomes of his/her assigned center, they will have a portion of their time allocated to direct patient care as a PCP and/or other clinical duties (amount dependent on number of direct reports). The remainder of their time is allocated to leadership responsibilities, including PCP performance, engagement, and building a strong clinical-operations synergy and culture. The allocation of time is dependent on several factors, including PCP capacity, market needs, size of centers, patient membership, and Market Clinical Director direction. ESSENTIAL JOB DUTIES/RESPONSIBILITIES: Independently provides care for patients with acute and chronic illnesses encountered in older adult patients. Takes full accountability for patient care and outcomes and appropriately seeks consultation from specialists when needed, though will still stay involved in, and be responsible for, the detailed care of the patient. Engages with the hospitalist whenever one of their patients is in the hospital (regardless of whether the hospitalist works for ChenMed or not). Responsible for assessment, diagnosis, treatment, management, education, health promotion and care coordination and documentation for patients with acute and complex chronic health needs. Leads their care team consisting of care promoter (medical assistant), care facilitator, and care coordinator for patients able to come to the office. For patients that are unable to come to the office-in hospital, SNF, LTC or homebound, engages with the transitional care team and others including case managers, acute and transitional-care physicians, and other resources that may be available depending on the market. Leads Super Huddle (SH) and Transforming Care Meeting (TCM) weekly, as well as supports Center Manager/Center General Manager center clinical leader and/or market clinical leader is not available, based on guidance from Market Chief Medical Officer. Fills in as needed for center clinical leadership needs, including monitoring daily center census as part of joint center accountability for outcomes. Plays an active role in the management of their center and helps cover for other providers who may be out for various reasons. It is also expected that each Clinical Director will take an active role as needed in recruiting patients for the center and recruiting and interviewing additional providers for the company. Managing, mentoring and coaching PCPs in his/her assigned center to deliver outstanding clinical outcomes, including sampling other PCP's daily huddles within their center Leadership rounding with the PCPs (reduced involvement of market clinical leader) Partnering with Center Operations Director/Market General Manager to drive continued improvement of center financial performance, and helping increase center membership Performs other duties as assigned and modified at manager's discretion. KNOWLEDGE, SKILLS AND ABILITIES: Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other applications used in the company Ability and willingness to travel locally as needed in their market, if applicable, nationally for initial training (2 weeks) and then occasionally regionally and nationally for recruiting or training purposes Fluency in English, verbal and written. There may be jobs in some centers that require fluency in other languages, and this will be made known at the time of application. This job requires use and exercise of independent judgment EDUCATION AND EXPERIENCE CRITERIA: MD or DO in Internal Medicine, Family Medicine, Geriatrics, or similar specialty required Current, active MD licensure in State of employment is required A minimum of 1-year clinical experience in geriatric, adult or family practice setting preferred, with Lead PCP ideally being a ChenMed PCP Partner Completion of Chen Medical training, including Masterful Conversations and meeting facilitation, as part of the individual development plan Board certification in Internal Medicine, Family Medicine, Geriatrics or similar specialty is preferred, Board Eligibility is required Once Board certified, PCP will maintain board certification in their terminal specialty by doing necessary MOC, CME and/or retaking board exams as required Must have a current DEA number for schedule II-V controlled substances Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required w/in first 90 days of employment PAY RANGE: $238,832 - $341,189 Salary EMPLOYEE BENEFITS We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day. Current Employee apply HERE Current Contingent Worker please see job aid HERE to apply

Contract Duration: 03 Months Location: Miami-Dade County (Hialeah: 33010, 33012, 33013, 33014, 33015, 33016, 33018, 33142, 33147). We are seeking a Bilingual Case Management Coordinator (Spanish/English) to support Medicaid Long Term Care/Comprehensive Program members in Miami-Dade County, FL. This is a work-from-home position that requires significant field travel (50-75%) for face-to-face member visits in homes, Assisted Living Facilities, and Skilled Nursing Facilities. The Case Management Coordinator is responsible for assessing, planning, implementing, and coordinating care management activities for members with supportive and medically complex needs. The role focuses on improving short- and long-term health outcomes through care coordination, education, and integration of community resources. Key Job Duties Coordinate case management activities for Medicaid Long Term Care/Comprehensive Program members Conduct telephonic and face-to-face comprehensive member assessments Develop, implement, and monitor individualized care plans Coordinate care with Primary Care Providers, skilled providers, and interdisciplinary teams Facilitate services including prior authorizations, condition management support, medication reviews, and community resources Conduct multidisciplinary reviews to achieve optimal healthcare outcomes Utilize motivational interviewing and influencing skills to promote member engagement and behavior change Educate and empower members to make informed healthcare and lifestyle decisions Experience & Qualifications Required Qualifications Bilingual (Spanish/English) - fluent in speaking, reading, and writing 1+ year of experience in behavioral health, long-term care, or case management Preferred Qualifications Managed care experience Case management and discharge planning experience Long-term care experience Education Bachelor's degree required, preferably in Social Work or a related field About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ************************ US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Recruter Details: Name: Umar Farooq Email: ********************************** Internal Id #26-00632

This role works closely with Care Team Operations, Clinical Operations, Behavioral Health clinicians (LMFT/LCSW/LPCC), Community Health Workers (CHWs), Compliance, Finance (for authorizations), Care Operations Associates, and external partners including hospitals, primary care providers, behavioral health agencies, housing providers, and community-based organizations. Responsibilities Serve as the primary point of contact for assigned members with behavioral health and psychosocial complexity, building trust through consistent, trauma-informed engagement. Conduct comprehensive, holistic assessments addressing behavioral health, substance use, functional status, social determinants of health, safety risks, and care gaps. Develop, implement, and maintain person-centered care plans that integrate behavioral, medical, and social goals; update plans following transitions of care or changes in condition. Coordinate services across the continuum of care, including behavioral health providers, primary care, hospitals, housing supports, transportation, social services, and community-based organizations. Conduct required in-person home or community visits based on acuity, risk stratification, and payer requirements. Support Transitions of Care (TOCs) by completing timely follow-up, coordinating post-discharge services, and reinforcing discharge instructions and medication understanding. Utilize motivational interviewing, behavioral coaching, and health education to promote engagement, adherence, self-management, and long-term member stability. Identify, escalate, and address behavioral health risks, safety concerns, service delays, benefit lapses, and environmental barriers using HHN escalation protocols. Coordinate and track referrals, appointments, transportation, and follow-ups to ensure continuity and timeliness of care. Maintain accurate, timely, and audit-ready documentation of all assessments, encounters, and interventions in eClinicalWorks (ECW) and other HHN systems. Meet or exceed HHN and health plan productivity standards, including outreach cadence, encounter requirements, documentation timeliness, TOC completion, and quality measures. Actively participate in multidisciplinary case reviews, care conferences, team huddles, and escalations with nurses, behavioral health clinicians, CHWs, care operations, and compliance. Assist members with plan navigation, eligibility redeterminations, social service applications, housing resources, and crisis intervention support. Communicate professionally with members and care partners using HHN-approved channels, including phone, RingCentral, secure messaging, and SMS workflows. Contribute to continuous quality improvement efforts by identifying workflow gaps, documenting barriers, and sharing insights to improve care delivery. Uphold confidentiality and comply with all HIPAA, Medi-Cal, ECM, and payer regulatory requirements. Remain flexible and responsive to member needs, including field-based work and engagement in community settings. Skills Required Bilingual (English/Spanish) proficiency required to support member engagement and care coordination. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field. Licensure: Licensed LMFT, LCSW, LPCC.; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.

The Patient Care Manager and RN Dual role involves supervising and coordinating clinical nursing services for home health patients, ensuring individualized and compliant care in collaboration with healthcare teams. This position requires managing patient referrals, clinician assignments, insurance approvals, and continuous patient assessments. The role emphasizes patient-centered care, leadership development, and work-life balance within a home health care setting. We are hiring a Patient Care Manager and RN Dual role with Home Health experience. At Caretenders Home Health, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serve-it truly is all about helping people. You can find a home for your career here. As a Patient Care Manager, you can expect: • opportunities to get closer to patients and provide quality support to your patient-facing teams • to be valued and respected by patients and their families • a sense of security, incredible team support, and flexibility for true work-life balance • leadership development opportunities Our Patient Care Manager and RN Dual role might be a great opportunity if you believe in putting the patient at the center of everything. Apply today! . The Home Health Patient Care Manager is responsible for the supervision and coordination of clinical services and provides and directs provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. • Provides clinical services within the scope of practice, as defined by the state laws governing the practice of nursing, in accordance with the plan of care, and in coordination with other members of the health care team. • Receives referrals, ensures appropriate clinician assignments, evaluate patient orders, and plot start of care visits. • Coordinates determination of patient home health benefits, medical necessity, and ongoing insurance approvals. • Ensures patient needs are continually assessed and care rendered is individualized to patient needs, appropriate and reasonable, meets home health eligibility criteria, and is in accordance with physician orders. • Reviews assessments and plans of care daily, per assigned workflow, and consults clinicians with recommendations, as appropriate. Current RN licensure in state of practice Current CPR certification required Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation Keywords: patient care manager, registered nurse, home health, clinical coordination, nursing care, patient assessments, insurance approvals, healthcare leadership, care plan management, RN licensure

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Telephonic clinical case management with Medicare population.Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs. Completes a Comprehensive Assessment and Plan of care.Will document in clinical systems to support legacy Aetna and Coventry membership.Provides BH consultation and collaboration with Aetna partners.Active participation in clinical treatment rounds.Active participation in team activities focused on program development. Innovative thinking expected.The majority of time is spent at a desk on telephonic member outreaches and computer documentation.Assist members with locating community based behavioral health resources.Required Qualifications3+ years of direct clinical practice experience An active and unrestricted clinical behavioral health license in state of residence is required (ex: LPC, LCSW, LMFT, LPCC, LISW, LSW) Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service Bilingual Spanish and English Preferred QualificationsCrisis intervention skills preferred Managed care/utilization review experience preferred Case management and discharge planning experience preferred Discharge planning experience Utilization review, prior authorization, concurrent review, appeals experience CCM preferred DSNP experience a plus Knowledge of Substance Abuse DisordersEducationMasters Degree in Social Work or Counseling required Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095.00 - $116,760.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.For more information, visit ***************************************** We anticipate the application window for this opening will close on: 01/30/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth. Be part of a team that makes a real difference. Enjoy the perfect balance of remote work and meaningful field visits in this flexible role. Central Illinois area residency required as you'll travel throughout the region (up to 200 miles/4 hours round trip) to provide personalized care for clients. This position offers professional autonomy while building valuable connections with patients across diverse healthcare settings throughout Central Illinois. Join our compassionate team and help make a positive difference in an injured person's life. As a Field Case Manager, you will work closely with treating physicians/providers, employers, customers, legal representatives, and the injured/disabled person to create and implement a treatment plan that returns the injured/disabled person back to work appropriately, ensure appropriate and cost-effective healthcare services, achievement of maximum medical recovery and return to an optimal level of work and functioning. In this role, you will: * Demonstrate knowledge, skills, and competency in the application of case management standards of practice. * Use advanced knowledge of types of injury, medications, comorbidities, treatment options, treatment alternatives, and knowledge of job duties to advise on a treatment plan. * Interview disabled persons to assess overall recovery, including whether injuries or conditions are occupational or non-occupational. * Collaborate with treating physicians/providers and utilize available resources to help create and implement treatment plans tailored to an individual patient. * Work with employers and physicians to modify job duties where practical to facilitate early return to work. * Evaluate and modify case goals based on injured/disabled person's improvement and treatment effectiveness. * Independently manage workload, including prioritizing cases and deciding how best to manage cases effectively. * Complete other duties, such as attend injured worker's appointments when appropriate, prepare status updates for submittal to customers, and other duties as assigned. Qualifications * Education: Associates Degree or Bachelor's Degree in Nursing or related field. * Experience: 2+ years clinical practice preferred. Workers' compensation-related experience preferred. * Skills: Ability to advocate recommendations effectively with physicians/providers, employers, and customers. Ability to work independently. Knowledge of basic computer skills including Excel, Word, and Outlook Email. Proficient grammar, sentence structure, and written communication skills. * Certifications, Licenses, Registrations: * Active Registered Nurse (RN) license required. Must be in good standing. * URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN, COHN-S, RN-BC, ACM, CMAC, CMC). * Travel: Must have reliable transportation and be able to travel to and attend in-person appointments with injured workers in assigned geography. * Internet: Must have reliable internet. Benefits We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $70,000 - $83,000 annually. In addition to the base salary, you will be eligible to participate in our productivity-based bonus program. Your total compensation, including base pay and potential bonus, will be based on a number of factors including skills, experience, education, and performance metrics. The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability. Don't meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles. #LI-MC1 Registered Nurse (RN), Nursing, Home Care Registered Nurse, Emergency Room Registered Nurse, Clinical Nurse, Nurse Case Manager, Field Case Manager, Medical Nurse Case Manager, Workers' Compensation Nurse Case Manager, Critical Care Registered Nurse, Advanced Practice Registered Nurse (APRN), Nurse Practitioner, Case Management, Case Manager, Home Healthcare, Clinical Case Management, Hospital Case Management, Occupational Health, Patient Care, Utilization Management, Acute Care, Orthopedics, Rehabilitation, Rehab, CCM, Certified Case Manager, CDMS, Certified Disability Management Specialist, CRC, Certified Rehab Certificate, CRRN, Certified Rehab Registered Nurse, COHN, Certified Occupational Health Nurse, CMC, Cardiac Medicine Certification, CMAC, Case Management Administrator Certification, ACM, Accredited Case Manager, MSW, Masters in Social Work, URAC, Vocational Case Manager

The Cuyahoga County Board of Developmental Disabilities (Cuyahoga DD) is seeking a manager to plan, direct and manage the provision of occupational, physical and speech therapy services to individuals eligible for Board services ages 3 and older. Primary liaison to community therapy partners and projects. The nature of work will include, but is not limited to the following: Provide clinical and strategic oversight to occupational, physical and speech therapists serving individuals ages 3 and older (adult therapy staff). Provide direct supervision, performance evaluations, guidance and feedback to OT, PT, and SLP consultative staff and Specialized Services Supervisor. Support the Specialized Services Supervisor in carrying out these responsibilities for the Specialized Services Therapy staff. Oversee and monitor all adult therapy staff with regard to adherence to policies and procedures for therapy provision, clinical practice and ethical standards. Review requests, assign referrals and prioritize the caseloads of adult therapists based on emergent needs. Provide support and guidance to Specialized Services Supervisor to assign and manage caseloads for specialized services staff, including direction with recommendations for therapeutic interventions/services/frequencies to best meet the needs outlined in the referral. Manage all activities of the EITS lending library and Mobile Sensory Space, including inventory management and outcome measurements. Build and expand partnerships with community organizations to increase the capacity to serve individuals with developmental disabilities. Develop and maintain relationships with entities including but not limited to private provider agencies, vendors and public school districts. Develop, coordinate and manage training of adult therapists and maintain standards for performance of evaluations, written plans and objectives, record keeping, implementation of treatment, technical competency, review of objectives, plans and treatment. Manage the support of individuals with complex and intense needs in Cuyahoga DD respite and ICF homes. Monitor elements and implementation of services delivered by adult therapists through analysis of programmatic, productivity and outcome data. Maintain and monitor data from the timekeeping system for consultative adult therapy staff, including professional leave requests, absences and timecards. Manage staff mileage reimbursement requests. Establish and coordinate opportunities to advance the professional growth of all adult therapy staff and Specialized Services Supervisor. Participate in the recruitment and hiring process for adult therapy staff including new employee orientation. Oversee all adult therapy department meetings and develop and coordinate agenda with Specialized Services Supervisor. Co-arrange vendor presentation and clinical in-service opportunities for department. Assist with the Adult Therapy Department budget. Complete initial and ongoing training for PBS-CR and monitor the initial and ongoing training completion for department staff. Coordinate shadowing and internship experiences for adult therapy students (OT, PT and SLP) of approved local colleges and universities outlined in contractual agreements with Cuyahoga DD. Oversee and monitor process for provision of adult therapy services to contracted intermediate care facilities. Participate in EITS Department work efforts related to agency committees, task forces or other initiatives as assigned. As necessary, represent Cuyahoga DD in dealings with other state, regional and local agencies and organizations. As necessary, attend and participate in meetings, committees, conferences and make presentation on applicable topics. Provide consultation services to management, administrative staff, and parents/guardians as part of general or specific training requests. SUPERVISORY DUTIES: Direct supervision of Specialized Services Supervisor and adult consultative Occupational, Physical and Speech therapy staff. FANTASTIC BENEFITS: All newly hired employees in this position walk through the door earning: Hybrid work schedule with some flexibility. Over 40 paid days off a year, including holidays. A great government Pension through Ohio PERS. Major Medical insurance. Free Dental, Vision Life, and Temporary disability Insurance Professional Development Reimbursement each year. Membership dues reimbursement each year. Mileage Reimbursement at the IRS rate. Flexible Spending Account Tuition Reimbursement Annual Pay Increases, and so much more. If you would like a much more comprehensive look at the benefits package, click HERE to download a pdf with more detailed information. SALARY: The starting salary for Pay Schedule F is $73,000.00. However, it is important to understand that the actual starting salary for a new hire into this position will be determined based on many factors including the breadth and depth of the knowledge, skills, education and experiences brought by the candidate. Also, it is Cuyahoga DD's intent to pay each employee a salary that is reasonable and competitive based on the market rate for the position, while also considering not only internal equity but also the budgetary constraints. The Cuyahoga DD recruits and retains outstanding individuals who are committed to our mission of supporting and empowering people with developmental disabilities to live, learn, work and play in the community. We seek to attract diverse staff who desire to inspire, to promote abilities and talents, to foster inclusion in all aspects of community life, and to hold themselves and others to high expectations. We hope you choose to join our team! Remote Work: Our positions are not 100'% remote. There is an onsite expectation for all of our positions. Although we may permit some remote work at home with hybrid work schedules for some of our positions, we do expect staff to be able to commute to our facilities in Cuyahoga County, Ohio on a regular basis. Travel between our four locations in Parma, Cleveland, and Highland Hills, Ohio is required. Qualifications Ohio license in physical or occupational therapy or speech language pathology required with the corresponding degree. Minimum three years' clinical experience as a Physical Therapist, Occupational Therapist or Speech Language Pathologist required. Minimum three years' clinical experience and at least two years' experience in the direct supervision of employees required. Minimum one year's experience in providing or overseeing direct services to individuals with complex needs. Training or experience in intellectual disabilities, developmental disabilities and appropriate treatment techniques preferred. Valid state of Ohio driver's license and continued maintenance of excellent driving record. Application Procedure: All applicants must apply ONLINE. Current Cuyahoga DD employees are required to upload at least a detailed letter of interest that outlines your interest in this position and highlights your qualifications for this position. External applicants are required to upload a resume that shows a detailed work history. This is important because this agency no longer requires that applicants complete an employment application. Therefore, the only way we will be able to review your employment history and ascertain your background and experience is through your resume. You are also encouraged to upload a cover letter that outlines your interest in this position. Resumes and letters are uploaded on your profile page once you apply for this position. Failure to provide a resume that outlines your work history will remove you from consideration. All candidates are asked to create an online profile and you may be asked to answer a series of questions. Immediately after applying, you will receive a confirmation of receipt by email. If you do not receive that email, check your spam folder. For any further questions about the application process, see the FAQ link below. Application Deadline: Open until filled. Equal Opportunity, Diversity, and Inclusion: The Cuyahoga County Board of DD is committed to treating every individual, family, employee, and applicant with dignity, respect and compassion regardless of a person's sex, ancestry, national original, race, color, age, religion, disability, military or veteran status, sexual orientation, gender identity/gender expression, genetic information, or social, economic or political affiliation. Compassion, trust, and mutual respect are at the core of our commitment to diversity and inclusion. The Cuyahoga County Board of DD fosters and promotes an inclusive environment that leverages the unique contributions of diverse individuals and organizations in all aspects of our work. We know that by bringing diverse individuals and viewpoints together we can collectively and more effectively create opportunities for a better life for the individuals we support. Diversity and inclusion are at the heart of what it means for people with developmental disabilities to live, learn, work, and play in the community. PRIVACY AND SECURITY NOTICE: By applying for positions with the Cuyahoga County Board of Developmental Disabilities you are accepting that you have reviewed and understand our Applicant Privacy and Security Notice provided by clicking HERE. - Individuals who may need assistance with the application process should contact Human Resources. - Questions about the application process? Review answers to our FAQs here: FAQS and How to Contact H.R. - All Job tentative offers are made with the understanding that prospective new employees pass a drug test and background check prior to being hired. Cuyahoga DD is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

The Medical Case Manager is responsible for providing comprehensive case management services at Equitas Health and identifying and assisting HIV+ persons needing case management services throughout Ohio. The individual will operate in accordance with the established professional standards and guidelines as stated by the Ohio Revised Code and put forth by the Ohio Counselor, Social Work, and Marriage and Family Therapist Board. The individual will operate in accordance with the established professional standards and guidelines for the National Association of Social Workers (NASW) and agree to adhere to NASW standards for social work management. ESSENTIAL JOB FUNCTIONS: Essential functions of the job include, but are not limited to, traveling, driving, having reliable transportation to transport clients and meet clients, and utilizing a computer for typing and conducting research, attending meetings, conducting assessments, and counseling. MAJOR AREAS OF RESPONSIBILITY: Provide high-quality case management for clients and their families by assisting them to access medical services, health insurance, Ryan White benefits, and other resources and services to improve health outcomes, housing stability, and employment and income attainment. Conduct comprehensive psychosocial assessments for people with HIV/AIDS seeking services at intake and complete update assessments each bi-annually and as needed. Medical Case Managers will assist clients in completing and submitting all necessary documentation related to these assessments. Develop, monitor, and evaluate individual care plans for each assigned client at intake, bi-annually, and as needed thereafter. Case Plans will address services provided to the client within Equitas Health, as well as services managed within the community by other providers. Function as a central and primary access point for financial assistance programs, including but not limited to Ryan White Treatment Modernization Act (Part B and C), HOPWA short-term rental assistance, and other assistance programs as appropriate. Medical Case Managers will complete and submit paperwork as is needed to support clients in maintaining these assistance programs. Assess the client's mental health needs and provide crisis intervention as necessary. Medical Case Managers are responsible for completing lethality assessment documentation and consulting with Supervisors whenever a crisis occurs. Medical Case Managers will also reach out to community mental health services and consult with ongoing Mental Health and Therapy Providers as appropriate. Assist client with linkage to resources such as housing, respite, nutritional assistance, palliative care, chore assistance, transportation, and social functions that help increase the client's ability to remain independent in the community. Navigate community workforce programs and provide supportive services to clients that address the unique barriers to employment PLWHA may face in returning to work, understanding benefits eligibility, confidentiality, and health management in the workplace. Provide transportation to and from appointments related to resource needs, medical needs, and other activities related to the client's ability to remain independent within the community. Identify and engage health care professionals in the region to provide quality services to HIV+ individuals and establish new relationships in collaboration with ODH. Medical Case Managers will refer Providers who seek a relationship with ODH to the appropriate contacts within ODH. Represent Equitas Health within the community, engaging other service providers and providing education about special needs associated with a client living with HIV/AIDS in the primary care continuum, mental health continuum, and other community resources. Works collaboratively within a multidisciplinary team. Maintain confidentiality of clients by adhering to Equitas Health Confidentiality Policy and Procedure, HIPAA, and other established professional standards and guidelines. Medical Case Managers are responsible to maintain documentation through Equitas Health, ODH, and other software systems. All documentation will be recorded and complete within two business days of provided service. Effective written and verbal communication skills. Ensure that action items and updates are provided to Supervisor proactively. Capture feedback from clients, staff, and community partners and communicate the information to the appropriate persons. Returns client, provider, and other stakeholder correspondence within 2 business days. Achieve productivity standards maintained by Equitas Health, including spending no less than 60% per month of hours worked directly engaging with clients, their families, and other informal supports. Participate in and complete Peer Review Audits monthly. Medical Case Managers will maintain scores of no less than 90% on monthly peer reviews. Coordinate with clients in order to maintain Active status through Ryan White and other programs. Medical Case Managers are responsible to have no less than 90% of their clients within a date or identified as active in any given month. Responsible for accurate and timely completion of the documentation in order to provide accurate data and reports to Equitas Health and its Board, as well as federal, state, and local governments. Attend training, as assigned, to improve case management skills related to written and verbal skills, putting theory into practice, and accurate documentation across multiple systems. Medical Case Managers will participate in Motivational Interviewing training and Learning Groups. As appropriate, Supervisors will schedule shadowing and review recorded visits between Medical Case Managers and clients in order to evaluate Motivational Interviewing skills. Participate in Equitas Health Committees and Performance Improvement Teams as appropriate and assigned by direct supervisor. Prepare for and attend individual and group supervision per the Supervisor's schedule. Medical Case Managers are responsible for bringing client concerns, process questions, and other needs to scheduled supervisions. Medical Case Managers are required to attend 8 hours of supervision per month. Demonstrates unconditional positive regard to clients; Conducts all aspects of job responsibilities with a focus on exceptional customer service. Demonstrates continuous growth and development of Cultural Competency exhibiting an understanding, awareness, and respect for diversity. Attend monthly, quarterly, and as-needed meetings in-person at multiple agency sites and community partner locations. Utilize email, Skype, phone, and other telecommunication options to participate in meetings across sites. Other duties as assigned are related to this position by the supervisor. KNOWLEDGE, SKILLS, ABILITIES, AND OTHER QUALIFICATIONS: Minimum of BS/BSW and LSW required. Must have sensitivity to, interest in, and competence in cultural differences, HIV/AIDS, minority health, sexual practices, and a demonstrated competence in working with persons of color, and the gay/lesbian/bisexual/transgender community. Community-based Case Management and training experience desired. Proficiency in all Microsoft Office applications and other computer applications required. Reliable transportation, driver's license, and proof of auto insurance required. Knowledge and adherence to social work standards and ethics. OTHER INFORMATION: Background and reference checks will be conducted. Hours may vary, including working some evenings and weekends based on workload. Individuals are not considered applicants until they have been asked to visit for an interview and at that time complete an application for employment. Completing the application does not guarantee employment. In accordance with Equitas Health's Drug-Free Workplace Policy, pre-employment drug testing will be administered. EOE/AA It is the policy of Equitas Health that no employee or applicant will be discriminated against because of race, color, religion, creed, national origin, gender, gender identity and expression, sexual orientation, age, disability, HIV status, genetic information, political affiliation, marital status, union activity, military, veteran, and economic status, or any other characteristic protected in accordance with applicable federal, state, and local laws. This policy applies to all phases of its personnel activity including recruitment, hiring, placement, upgrading, training, promotion, transfer, separation, recall, compensation, benefits, education, recreation, and all other conditions or privileges of employment. Equitas Health values diversity and welcomes applicants from a broad array of backgrounds.

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. Position Overview The Medical Review (MR) Manager is responsible for overseeing all medical review activities and quality assurance functions for the CMS Review and Validation Contractor (RVC) program. This role ensures accurate application of Medicare policy, directs daily workflow for medical review staff, and supports the validation of Recovery Audit Contractor (RAC) determinations. The MR Manager must be available Monday-Friday, 8:00 AM to 4:30 PM ET. Key Responsibilities Manage and oversee medical review operations, including accuracy reviews, disputes, RAC topic evaluations, and special studies. Lead and supervise medical review staff to ensure proper application of Medicare policies and procedures. Provide clinical expertise and guidance for complex or questionable claim review situations. Conduct quality assurance (QA) audits to verify compliance with contract and regulatory requirements. Brief, train, and educate review personnel on policy interpretation and validation processes. Stay current on medical practice, technology changes, billing trends, and potential areas of improper payments. Ensure medical review activities align with CMS FFS Recovery Audit Program requirements. Serve as the clinical resource for Medicare coverage, documentation, coding, and regulatory requirements. Maintain timely communication with CMS and internal leadership as required. Ensure that all duties requiring clinical expertise are performed directly by the MR Manager; non-medical staff may not substitute. Required Qualifications Minimum of 5 years of medical review experience. Minimum of 3 years of experience as a Medical Review Manager, including QA oversight. Extensive knowledge of the Medicare program, including coverage, payment, billing, and policy requirements. Working knowledge of the CMS Fee-for-Service (FFS) Recovery Audit Program. Strong analytical and decision-making skills with demonstrated clinical judgment. Education and Licensure Registered Nurse (RN), currently licensed in the United States or U.S. Territory (license verified annually). Bachelor's degree in Nursing (BSN) required. Core Competencies Medical review expertise Clinical judgment and decision-making Medicare coverage and policy knowledge Quality assurance and audit experience Leadership and staff management Policy interpretation and training Strong written and verbal communication Attention to detail and accuracy Work Schedule Monday through Friday 8:00 AM to 4:30 PM ET Availability required during these hours for CMS and operational needs What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

We are a nationally recognized healthcare management organization with over 40 years of experience delivering innovative, high-quality clinical solutions. Our mission is to improve member health outcomes by identifying risk, promoting treatment compliance, and delivering personalized care. Position Summary The Director of Utilization Management & Case Management provides strategic and operational leadership for UM and LCM programs. This role is responsible for driving clinical excellence, regulatory compliance, process improvement, and team performance while partnering with senior leadership, clients, and sales to support continued growth. Key Responsibilities Lead and manage UM and LCM teams, fostering high performance and professional development Ensure compliance with URAC standards and applicable state regulations Drive process improvement, efficiency, and automation initiatives Serve as clinical and operational SME for business development and new product launches Collaborate cross-functionally with Sales, Client Services, Clinical, and IT teams Support client relationships, reporting reviews, and strategic planning Participate in sales presentations and client meetings as needed Qualifications Bachelor's degree in healthcare, business, or related field Clinical background with healthcare leadership experience Progressive management experience in healthcare operations Experience working with senior leadership and external clients Experience in utilization management and case management Experience with self-funded groups and InterQual criteria preferred Strong communication, analytical, and leadership skills Ability to travel as needed (approximately 10%) Compensation & Benefits Competitive salary based on experience Comprehensive benefits package including medical, dental, vision, 401(k), PTO, and more Join Our Team If you are a strategic, results-driven healthcare leader ready to make an impact, we invite you to apply.

Job Description TITLE: Director Case Management / Utilization Management / CDI Now is your chance to join a Forbes magazine top 100 hospital where career growth and opportunity await you. They are committed to building healthcare teams whose care exceeds the expectations of their patients and community and are looking for quality talent who share the same values. They're nestled in a beautiful rural setting but close enough to the big city to enjoy that too! If that sounds like the change you are looking for, please read on… What you'll be doing: •Responsible for developing, planning, evaluating, and coordinating comprehensive patient care across the continuum, to enhance quality patient care while simultaneously promoting cost-effective resource utilization. Provides director-level oversight of Inpatient and ED Case Management, Utilization Management and Clinical Documentation Integrity programs, ensuring alignment with organizational goals and regulatory requirements. Monitors patient care, including utilization, quality assurance, discharge planning, continuity of care, and case management activities, and ensures that these functions are integrated into overall hospital operations. Coordinate and monitors activities with appropriate members of the health care team to promote efficient use of hospital resources, facilitate timely discharges, prevent and control infections, promote quality patient care, and reduce risk and liability. Collaborates closely with coders and revenue cycle teams to optimize clinical documentation and support accurate coding, reimbursement, and compliance initiatives. •Responsible for identifying tracking mechanisms in order to evaluate and achieve optimal financial outcomes, to enhance quality patient care, and promote cost-effective resource utilization. •Uses data to drive decisions, plan, and implement performance improvement strategies for case management, utilization management, and clinical documentation integrity •Coordinates daily activities of the Case Management, UM, and CDI Department in order to promote quality patient care, efficient use of hospital resources, facilitate timely and adequate discharges, and reduce risk and liability. •Investigates and initiates follow-up on utilization denials, contract negotiations, and external regulatory agencies' requirements. •Directs operations of our Physician Advisor Program, including analysis of performance through reporting and committee involvement and oversight. •Actively serves on hospital committees and teams and facilitates opportunities for employees to do the same. •Develops, performs, and improves personal and departmental knowledge of computer software and reporting functions. •Organizes and oversees the maintenance of denial and appeal activity. Follows up with physicians and others when indicated. •Prepares or coordinates the preparation of periodic and special reports required by various agencies, insurance contracts, and for hospital committees. •Analyzes and trends data results in order to incorporate efforts and information results with existing systems to optimize the efficiency of operational systems through strategic quality leadership. •Facilitates growth and development of the case management program, utilization management ( including physician advisor program and clinical documentation integrity (CDI), in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities, as needed. •Develop new resources where gaps exist in the system as identified through research and data analysis to meet and enhance the quality/efficiency of comprehensive patient care and/or basic human needs for the community. •Interact with Corporate Consulting and Business office on issues such as contracting, billing, reimbursement, denials, and physician reports cards, and collaboratively initiate improvements related to these areas. •Maintains hospital compliance with the Quality Improvement Organization (QIO) and CMS guidelines. •Maintains professional knowledge by participating in educational seminars and opportunities. •Participates in Population Health work at an organizational level, including active involvement with the System-Wide Care Management Team and Value-Based Care Delivery. Additional info: •Position will report to a Manager that is well respected in the organization. Position is open as the person is retiring. They use EPIC(EMR) and the facility has a lot of technology. Person would be over about 50-60 people between CM/UM/CDI. Great team to work with. •If you're a passionate Pharmacist and seeking a rewarding career in a collaborative healthcare setting, this is the opportunity you've been waiting for. Join us in east central Ohio, and become part of our exceptional team dedicated to delivering high-quality care to our community. Apply now and embark on a fulfilling career journey with us. Requirements What they're looking for: •Master's degree in nursing, Healthcare Administration, or Business Administration required. •Current Ohio RN licensure (or active multi-state licensure). •Certified Case Manager(CSM). •At least three (3) years of management or demonstrated leadership experience required. •Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning, and continuum of services offered within Genesis and externally. Knowledge of coding, mid-revenue cycle, CDI, physician advisor and payor relations. •Ability to perform data analysis and to utilize computer systems to record and communicate information to other services. •The ability to lead collaboration with other leaders in the organization, especially about the delivery of high-quality, timely, and right site of care. •Excellent leadership, verbal and organizational skills to order to steer the case management process. Benefits Hours and compensation potential: •The position is full time. •The range starts at $62.50hr($130K)-$75hr($156K) depends on years of experience. •Full benefits package being offered.

**_What Finance Operations contributes to Cardinal Health_** Finance oversees the accounting, tax, financial plans and policies of the organization, establishes and maintains fiscal controls, prepares and interprets financial reports, oversees financial systems and safeguards the organization's assets. Finance Operations is responsible for core financial operation processes. This can include customer and vendor contract administration; customer and vendor pricing, rebates, billing vendor chargeback research and reconciliation; processing vendor invoices and employee expense reports for payment; fixed asset accounting for book and tax records; cash application; and journal entries. + Demonstrates knowledge of financial processes, accounting policies, systems, controls, and work streams + Demonstrates experience working in a transnational finance environment coupled with strong internal controls + Possesses understanding of service level goals and objectives when providing customer support + Works collaboratively to respond to non-standard requests + Possesses strong organizational skills and prioritizes getting the right things done **_Responsibilities_** + Manage a team of Cardinal Health and Genpact individuals who oversee the entirety of the GPO Admin Fees and Rebates set up and report creation functions, including P&L accruals, rebate setups within SAP Vistex and ad hoc reporting for key internal and external stakeholders. Responsible for the month end accounting close process. + Ensure GPO Admin Fees and Rebates are properly accounted for based on core accounting principles + Own first level review/approval responsibilities for non-standard rebate structures to ensure proper audit documentation is maintained and proper approvals are received + Oversee key rebate accuracy and timeliness CSLs and KPIs + Partner with cross-functional teams to research and resolve root cause issues impacting rebate accuracy or ability to set up Rebates and GPO Admin Fees timely; apply big picture knowledge to assess and interpret financial impact of process changes and resulting driver outcomes of GPO Admin Fee/Rebate set up changes + Foster a strong SOX internal control structure and seek opportunities for improvements, including build out of SOP processes and project development + Transform current payout and reporting process into Vistex implementation and go-forward build/upkeep + Develop plans for future systematic enhancements + Assist team with more complicated customer and transaction activities; oversee escalations to ensure closure in a timely manner + Partner with and be a thought-provoking leader to business partners across the organization to properly account for transactions, including but not limited to Sales, Legal, Finance, Pricing, Accounting and Contracting + Actively collaborate and support cross-functional team initiatives to improve customer experience, both internally and externally + Establish team and individual-oriented goals for growth and development **_Qualifications_** + Bachelor's Degree in Accounting, Finance or Business Management, preferred + CPA preferred + 8+ years of professional experience in related field, preferred, including Accounting, Finance, or Audit, preferred + Accounting and Finance acumen + Ability to lead a new team and influence others + Knowledge with SAP and legal contracts (revenue recognition standards is a plus) + Data mining experience (relevant application tool experience is a plus) + Strong written and verbal communication skills + Process improvement oriented + Strong SOX/internal control understanding **Anticipated salary range:** $105,100 - $135,090 **Bonus eligible:** Yes **Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being. + Medical, dental and vision coverage + Paid time off plan + Health savings account (HSA) + 401k savings plan + Access to wages before pay day with my FlexPay + Flexible spending accounts (FSAs) + Short- and long-term disability coverage + Work-Life resources + Paid parental leave + Healthy lifestyle programs **Application window anticipated to close:** 1/16/2026 *if interested in opportunity, please submit application as soon as possible. The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity. _Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._ _Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._ _To read and review this privacy notice click_ here (***************************************************************************************************************************

Facilitates the rehabilitation process for adults with severe and persistent mental illness. Provides monitoring and coordinates the delivery of necessary evaluation and assessments to identify the patient needs, development of the rehabilitation plan, linkage and coordination of appropriate community services. Assists with independent skills training; advocacy for financial, medical and legal entitlements. Arranges for crisis intervention. Services are mobile and delivered primarily in the community. The Case Manager works under the supervision a licensed clinician and is assigned a complex caseload with multiple and varied problems based on experience, expertise and education. Patients with severe and persistent mental illness who are assigned may present a history of significant risk to themselves and/or others. Responsibilities In conjunction with the supervisor, prepares and reviews periodically an individualized service plan with the patient and assists the patient/service providers in achieving service plan objectives. Revises service plan with the patient at annual reviews and as care needs changed. Possesses knowledge of community resources and coordinates all needed referrals for residential, financial, vocational, psychiatric, educational, health and counseling needs. Represents MHS to the community caregivers, citizens, and community leaders, explaining MHS policies. Collects patient collateral information from involved providers such as physicians, hospitals, private practitioners, Court officials and other care givers. With the patient, identifies and prioritizes problems , needs and opportunities so that level of assistance can be determined. Charts patient's progress in their clinical record and completes all paperwork necessary by MHS policy for professional, administrative, financial, and evaluative purposes of monitoring clinical care and of assuring efficient and effective agency operations. Ensures that the needed release forms are signed and correct. Maintains a professional relationship and provides face to face contacts with patients regardless of service environment (e.g. residential, inpatient). Screens for pain and encourages patient to follow up with a health care provider of their choice. Delivers mobile services which are community based. Engages in outreach, problem solving, advocating, crisis intervention, skills training. In consultation with supervisor, addresses urgent needs such as stabilization, medication, homicidal and suicidal behaviors by assisting the patient in accessing appropriate intervention. Presents patient cases for review with team and/or supervisor. Consults with other providers and community caregivers to strengthen and coordinate social intervention programming. Identifies deficits in community resources and forwards them to supervisor. Is responsible to deliver the number of units of service budgeted by the Vice President in order to assure the fiscal viability of MHS. Participates in quality improvement activities when appropriate. Actively assesses patients for crisis stabilization and intervenes during signs of crisis, utilizing de-escalation techniques and crisis management skills. Assist patients with entitlements. Follows all universal precautions for safety, infection control and follows all state, federal and joint commission health and safety standards. Treats patients and family with dignity and respect at all times, and holds all patient information in the strictest confidence. Adhere to professional standards, policies and procedures, federal, state and local requirements and Joint Commission standards, including National Patient Safety Goals. Presents a positive image of MHSCC to other community agencies, caregivers and citizens Completes all MHS required education and training, including initial agency orientation, mandatory trainings and educations, and up keep of all required certifications and licensure as required by state, federal and regulatory requirements. Demonstrates organizational stewardship and exemplifies the mission, vision and values of MHS. Performs other job-related tasks as assigned Education/Experience High School diploma or equivalent with 3 years' experience in mental/behavioral health (required) -OR-- Associate or bachelor's degree in a social/human services related field (preferred) Experience with SUD/Dual Diagnosis preferred Licensure/Certifications Valid OH drivers license, valid auto-insurance and be able to meet the MHS liability insurance standards CDCA/LCDC (Preferred) Ability to be credentialed as a QMHS within 30 days of hiring NVCI CPR(BLS)/First Aid MHS provides CPR (BLS)/First Aid and NVCI (CPI Blue Card) for all new staff, along with on-going education and on-the-job training opportunities . All MHS candidates are required to have an Ohio BCI check (FBI check required if you have lived in Ohio for less than 5 years, or for working with children), 5-panel drug screen and Residential candidates must have a 2-step TB (or proof of prior TB) upon conditional offer of employmen

Job Description Responsible for interacting with low stratification members via phone calls, coordinating care, completing, reviewing, and updating assessments and care plans that address problems, goals, and interventions. Based on assessments and claims data creates a care plan for members to follow 70% Participate as a member of the Care Team during Interdisciplinary Team meetings to discuss the members health care needs, barriers to care and explore better outcomes for the member 20% Identify and link members with health plan benefits and community resources 5% Perform administrative work to maintain skills needed for job duties 5% 5% Experience: Required: 2 years LPN Nursing exp, preferred 3 + years experience. Regular and reliable attendance Familiar with community resources & services Strong organizational skills Works independently. Maintains professional relationships with the members we serve as well as colleagues. Communicates effectively and professionally verbally and in writing. Proficient with computer systems Knowledgeable in Microsoft Office Software Excellent customer service skills Has a dedicated home work space Position Summary: Looking for Columbus OH and immediate surrounding counties. The Care Manager Specialist is a member of the Care Team. The Care Manager Specialist is responsible for the care management of members that are enrolled in the Dual Special Needs Plan. These members are usually stratified as low medium stratification, or those with Social Determents of Care needs. The Care Manager will work in conjunction with the Nurse Care Manager, Care Coordinator, Transition of Care (TOC) Coach, and other members of the Care Team to improve the members health outcomes, address social determinants of health and connect members with community-based organizations. The Care Manager will assess members needs as well as gaps in care, communicate with the members Primary Care Provider (PCP), maintain updated individualized care plans, and participate in Interdisciplinary team meetings. Care Managers will be able to identify members whose needs require clinician involvement and transition members appropriately. Complete health screening questionnaires, assessments which may be market specific. Support reduction of population of unable to reach members by telephone and in -person visits. Ensure member has filled/received their medication(s) and has an understanding on how to take their ordered medications. Manage caseload of members with current stratification of monitoring, low and medium or those with high social determinants of care needs- frequency /contract guidelines Provides clinical assistance to determine appropriate services and supports due to members health needs (including but not limited to: Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management, Community Resources and supports) Evaluation of health and social indicators Identifies and engages barriers to achieving optimal member health. Uses discretion to apply strategies to reduce member risk. Presents cases at case conferences for multidisciplinary focus to benefit overall member management. Facilitates overall care coordination with the care team to ensure member achieves optimal wellness within the confines of the members condition(s) and abilities to self-manage. Coordinates resources, assists with securing DME, and helps to ensure timely physician follow-up. Understands Payer/Plan benefits, policies, procedures, and can articulate them effectively to providers, members, and other key personnel. Updates the Care Plan for any change in condition or behavioral health status. Provide support to members in transitions of care Education: HS or equivalent, must be licensed LPN. What Days & Hours will the Person Work in this Position List Training Hours, if Different. M-F 8-5

Telephonic Case Manager - Rare Opportunity! EK Health is now hiring for a Telephonic Nurse Case Manager (RN) for our Case Management Team! This role includes assessing, planning, implementing, coordinating, and evaluation of service options. The goal of the Case Manager is to assist the injured worker in receiving appropriate, cost-effective medical care for their injury in a timely manner, and to expedite their return to work. Position Logistics: Monday - Friday, 8:30am -5:30pm local time, Full-time Remote. NOTE: Requires a Compact RN license in good standing. Workers Compensation experience is preferred but not required. Wage is based on experience, education, certifications and location (may be either hourly or salary based on individual state requirements). Benefits & Perks: Base pay $35-42/hr ($72,800 - $87,360 annually). Wage is based on experience, education, certifications and location (may be either hourly or salary based on individual state requirements). Medical, Dental and Vision Insurance 401K Paid Time Off Paid holidays Equipment is provided Monthly internet stipend Here's a snapshot of what you'll be doing (not all-inclusive): Communicate with medical providers, employers and with injured workers Perform a complete nursing evaluation to determine needs of patient Review and evaluate all medical correspondence, provider reports, & treatment plan history Evaluate clinical status of claimant and research for alternative options to treatment as warranted Communicate with the claims examiners regarding directives, and provide updates on file status Arranging transportation services when necessary and authorized Evaluating therapy facilities and their progress on specific cases Prepare comprehensive notes following any discussions had with injured worker, medical providers, claims examiners, and employers in the case file Discuss the analyzed data and the comprehensive plan of care with the insurance representative prior to implementation Upon authorization, implement this plan of care with patient, physician and health care providers Arrange for care/services as needed (home care, procedures, medication, equipment or supplies) Monitor the plan of care with modifications or changes suggested to the patient and physician as the need arises Coordinate information between all parties (injured worker, physicians, employer, other providers, such as therapists, and attorney, if any is involved) Requirements Graduate of an accredited school of nursing 3-5 years clinical experience as an RN outside of school Valid Compact RN license in good standing with no restrictions Valid state-appropriate RN license in good standing with no restrictions Possesses and can demonstrate the professional and technical skills of a Registered Nurse Experience in Case Management, Workers' Compensation experience preferred, but not required Experience in Home Health Care, Occupational Health considered a plus Excellent Written and Oral Communication Skills Excellent Interpersonal & Organizational Skills High comfort level with computers and computer programs (MS Word, MS Excel, Email)

Nurse Case Manager - Internal (Medical Review Nurse - PN 20014026) (250009CG) Organization: HealthAgency Contact Name and Information: Gayla. A will contact you if selected for interview.Unposting Date: OngoingWork Location: Health Department Building 246 North High Street 1st Floor Columbus 43215Primary Location: United States of America-OHIO-Franklin County-Columbus Compensation: $34.96Schedule: Full-time Work Hours: Monday - Friday; 8am - 5pmClassified Indicator: ClassifiedUnion: 1199 Primary Job Skill: NursingTechnical Skills: Health Administration, Nursing, Public Health, Public Relations, Medical records Professional Skills: Analyzation, Attention to Detail, Collaboration, Consultation, Verbal Communication, Written Communication Agency OverviewNurse Case Manager- Internal (Medical Review Nurse) About Us:Our mission at the Ohio Department of Health (ODH) is advancing the health and well-being of all Ohioans. Our agency is committed to building a modern, vibrant public health system that creates the conditions where all Ohioans flourish.The Bureau of Maternal, Child, and Family Health (BMCFH)/ Complex Medical Help (CMH) is organized to support families by improving birth outcomes and the health status of women, infants, children, and youth, including children and youth with complex health care needs. Using data and proven practice, the bureau's programs support the delivery of direct services, linkages and referrals, population-based supports, program evaluation, education, monitoring and quality oversight, and policy and systems development. Job DescriptionWhat You'll Do:Are you a compassionate and detail-oriented nurse looking to make meaningful impact in the lives of children with special care needs? This role offers a dynamic blend of clinical decision-making, case management, community engagement, and administrative support-ideal for nurses who thrive in both independent and collaborative environments. Duties Include: Clinical and Case Management: Independently assess medical applications and determine eligibility for CMH services. Authorize or deny diagnostic, treatment, and service coordination based on medical data and program guidelines. Interpret medical plans for treatment and develop appropriate care strategies. Monitor ongoing service needs and effectiveness, ensuring compliance with HIPAA and CMH policies. Coordinate complex treatment plants with other state and federal programs. Evaluate diagnoses and determine appropriate services, including medical equipment, orthotics, prosthetics, and orthodontia. Manage case data and service authorizations.Community Engagement & Education: Maintain contact with families, providers, and community partners through phone, written communication and site visits across Ohio. Provide technical assistance and orientation to providers on CMH policies, procedures and billing. Plan and participate in educational workshops, seminars, and nursing care conferences. Resolve service delivery issues and respond to sensitive inquiries professionally and confidentially. Collaborate with nurse case managers and other stakeholders to ensure timely and effective case processing Administrative and Liaison Support: Maintain accurate and confidential client records in accordance with national, state and CMH guidelines.Perform administrative tasks such as answering phone, managing documents and operating office equipment.Serve as a liaison to government agencies, private sector partners and other state programs UNUSUAL WORKING CONDITIONS: May require travel Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes: Medical Coverage Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including vacation, personal, sick leave and 11 paid holidays per year Childbirth, Adoption, and Foster Care leave Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more) Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.QualificationsPosition Qualifications: Current and valid license to practice professional nursing as Registered Nurse (i.e., R.N.) in Ohio as issued by Board of Nursing pursuant to Section 4723.03 of Revised Code and all of the following bulleted criteria: 24 mos. exp. in pediatric nursing, which included care of children with special health care needs (i.e., CSHCN) &/or case management of children with multiple health care needs completion of undergraduate core program in nursing to include 1 course in community health nursing or public health nursing & 1 course in research methodologies or equivalent.1 course or 3 mos. exp. in operation of personal computer. Or Current and valid license to practice professional nursing as Registered Nurse (i.e., R.N.) in Ohio as issued by Board of Nursing pursuant to Section 4723.03 of Revised Code and all of the following bulleted criteria: 24 mos. exp. in pediatric nursing, which included care of children with special health care needs (i.e., CSHCN) &/or case management of children with multiple health care needs. 24 mos. exp. in nursing, which included 3 mos. trg. or 3 mos. exp, in community health or public health nursing & 3 mos. trg. or 3 mos. exp. in data collection & analysis.1 course or 3 mos. exp. in operation of personal computer. Or Equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure. Additional Qualifications: Applications of those who meet the minimum qualifications will be further evaluated against the following criteria:Graduate or advanced degree in nursing Experience in pediatric nursing and case management of children/ young adults with special health care needs Experience providing technical assistance/consultation services to a local health department or other provider of child /young adults health services (e.g., hospitals, pediatric clinics, physician's offices, other health care related professionals) Experience in public/community and/or home health nursing Experience reviewing and authorizing medical plans of treatment/requests for services (e.g., may include durable medical equipment/orthotics/prosthetics/orthodontic services/therapies) Certified Nurse Case Manager/ Discharge Planner or Certified Pediatric NurseExperience in analyzing health related data to prepare reports (e.g., quality assurance/technical reports, medical reports) Experience providing education or training to various groups (e.g., medical groups, nursing staff, parents, young adults) Experience with computer software (e.g., Microsoft Office: Word, PowerPoint) All eligible applications shall be reviewed considering the following criteria: qualifications, experience, education, active disciplinary record, and work record Job Skills: NursingTechnical Skills: Health Administration, Medical Records, Nursing, Public Health, Public RelationsProfessional Skills: Analyzations, Attention to Detail, Collaboration, Consultation, Verbal Communication, Written CommunicationsEducational Transcript Requirements: Official educational transcripts are required for all post-high school educational accomplishments, coursework or degrees claimed on the application. Applicants will be required to submit an official transcript prior to receiving a formal offer of employment. Failure to provide transcripts within five (5) working days of being requested will cause the applicant to be eliminated from further consideration. Please note that a transcript is considered "official" only if it is an original copy from the educational institution and includes an institutional watermark, ink stamp or embossed stamp. Transcripts printed from the institution's website will not be accepted. ODH reserves the right to assess the academic credibility of an educational entity's award of a putative degree.If you are using education or coursework to meet the minimum qualifications for this position, an official transcript must be attached prior to submitting your application. Supplemental InformationSupplemental Information:ALL ANSWERS TO THE SUPPLEMENTAL QUESTIONS MUST BE SUPPORTED BY THE WORK EXPERIENCE/EDUCATION PROVIDED ON YOUR CIVIL SERVICE APPLICATION.Unless required by legislation, the selected candidate will begin at Pay Grade 13, Step 1 of the SEIU/1199 union Pay Range Schedule ($34.96 per hour), with an opportunity for pay increase after six months ($36.65 per hour) of satisfactory performance and then a yearly raise thereafter. APPLICATION PROCEDURES: All applicants must submit a completed Ohio Civil Service Application using the TALEO System. Paper applications will not be considered. Applicants must clearly indicate how they meet the minimum qualifications and/or position specific minimum qualifications. Applicants are also encouraged to document any experience, education and/or training related to the job duties above. An assessment of these criteria may be conducted to determine the applicants who are interviewed.STATUS OF POSTED POSITION:You can check the status of your application online by signing into your profile. Jobs you applied for will be listed. The application status is shown to the right of the position title and application submission details.BACKGROUND CHECK NOTICE:The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.All final applicants tentatively selected for this class will be required to submit to urinalysis to test for illegal drug use prior to appointments. An applicant with a positive test shall not be offered employment.ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

Company Details Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker's successful and speedy return to work is good for people and good for Berkley's insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley's operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers' compensation cases. To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley's operating units with reliable results, and reduced time and expenses associated with case management. Responsibilities As a Telephonic Nurse Case Manager, you will assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers. Coordinate and implement medical case management to facilitate case closure Timely and comprehensive communication with with employers, adjusters and the injured workers. Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care Review and analyze medical records and assess data to ensure appropriate case management process occurs while providing recommendations to achieve case progress and movement to closure Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction Acquire and maintain nursing licensure for all jurisdictions as business needs require Coordinate services to include home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate and evaluate cost effectiveness and quality of services Document activities and case progress using appropriate methods and tools following best practices for quality improvement Reviewing job analysis/job description with all providers to coordinate and implement disability case management. This includes coordinating job analysis with employer to facilitate return to work. Engage and participate in special projects as assigned by case management leadership team Occasionally attend on site meetings and professional programs Foster a teamwork environment Maintaining and updating evidence based medical guidelines (such as Official Disability Guidelines, MD Guidelines and all required state regulated guidelines) in reference to the injured worker treatment plan and work status. Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed. Obtain case management professional certification (CCM) within 2 years of hire Qualifications Minimum 2 years of experience in workers compensation insurance and medical case management preferred Minimum of 4 years medical/surgical clinical experience required Ability to work standard business hours in the either Central Standard Time, Mountain Standard Time or Pacific Time Zone (Monday through Friday, 8:00 AM to 5:00 PM CST/MST/PST). Exhibit strong communication skills, professionalism, flexibility and adaptability Possess working knowledge of medical and vocational resources available to the Workers' Compensation industry Demonstrate evidence of self-motivation and the ability to perform case management duties independently Demonstrate evidence of computer and technology skills Oral and written fluency in both Spanish and English a plus Education Graduate of an accredited school of nursing and possess a current RN license. A Compact Nursing License is strongly preferred. A California license is ideal but not mandatory. Candidates must be willing and able to obtain a California license within 90 days of their start date. Additional Company Details ****************** The Company is an equal employment opportunity employer We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees • Base Salary Range: $80,000 - $88,000 • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Additional Requirements • Domestic U.S. travel required (up to 10% of time) Sponsorship Details Sponsorship not Offered for this Role

Senior Care Case Manager Quality Moments is looking for a compassionate, reliable, and friendly individual to provide therapeutic activities and companionship to individuals in skilled nursing facilities. Do you have an inherent respect and compassion for elders? Do you believe all individuals should be treated with dignity and provided with support throughout aging? Are you energized and fulfilled by building meaningful relationships and enriching the lives of others? If this sounds like you, Quality Moments wants to hear from you. The Senior Care Case Manager is an excellent opportunity to enrich the lives of seniors through individualized activities related to social, emotional, and behavioral well-being. Quality Moments is looking for an individual whose desire to serve others aligns with our value of personal connection, keeping commitments, and putting people first in our lives. Qualifications and Responsibilities of Senior Care Case Manager Desire to improve quality of life for aging adults. Must have experience working with Alzheimer patients. High level of commitment, dependability, and interpersonal skills. Prior experience as an STNA, CNA, or in a nursing or long-term care setting is preferred. Prior experience in social work, counseling, human services, or a related field is preferred. Valid driver's license and reliable transportation with current automobile insurance meeting state minimum liability requirements. Previous EHR system use, and professional documentation experience are helpful.