Patient care manager jobs near me - 266 jobs

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities. Summary: This position ensures delivery of evidence-based practice by professional nursing personnel and other staff in designated areas of responsibility. He/She plans, organizes, directs and evaluates the unit's delivery of evidence-based patient care in a cost-effective manner, providing leadership and clinical management to members of the health care team. He/She participates in integration of the Nursing Philosophy along with the mission, vision, values, goals and objectives of OhioHealth in unit operations. Responsibilities And Duties: 1. 40% DEPARTMENT MAN Minimum Qualifications: Bachelor's Degree (Required), Master's DegreeLISW - Licensed Independent Social Worker - Social Work Certification and Licensure Board, LPCC - Licensed Professional Clinical Counselors - American Counseling Association, RN - Registered Nurse - Ohio Board of Nursing Additional Job Description: May require advance training in specialty areas. Specialized knowledge in nursing process and clinical skills. Demonstrated skills in interpersonal relationships, verbal and written communication and nursing practice standards. Skills in computer applications as appropriate to area(s) of responsibility. 2-3 years nursing experience in related or similar areas of responsibility. Previous leadership experience such as precepting, charge role, clinical lead role, mentoring, department committee leadership or facilitation of meetings. Work Shift: Day Scheduled Weekly Hours : 40 Department HVP Pickerington Join us! ... if your passion is to work in a caring environment ... if you believe that learning is a life-long process ... if you strive for excellence and want to be among the best in the healthcare industry Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The Global insurance Clinical Care Manager - Bilingual Japanese RN will perform prospective, concurrent, and retrospective reviews and non-urgent travel requests for Global Expat members located outside the United States. This is a 24/7 operation, and while your primary schedule will follow the hours listed above, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member outreach and any associated case review and documentation. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. This position supports the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs. Primary Responsibilities: A GI CCM must consider both US and international care standards and regulatory guidelines. They must be able to work in multiple platforms and comfortable communicating with members and providers to obtain information needed to perform the clinical review Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims 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: Registered Nurse with an active unrestricted United States license Must be bilingual in Japanese and English, with strong verbal and written communication skills 3+ years of experience in medical-surgical inpatient acute care Experience with working in collaboration with Medical Director to review care plans make recommendations. Ability to advocate on behalf of the member's needs while considering contractual limitations Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals Proven communication skills at all levels Proven ability to be flexible and display a positive attitude Proven solid problem-solving, organizational and crisis management skills Proven ability to function confidently and efficiently in fast paced work environment Proven ability to foster team cohesion in an international virtual environment Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations Demonstrated cultural competence and awareness of the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of expatriates, business travelers and UHC Global members Proven advanced software skills with ability to work in multiple platforms with clinical case reviews Proven advanced skills with Microsoft Office - Excel, Word Ability to work in the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs Preferred Qualifications: Bachelor's degree 2+ years of experience in utilization management or case management in a managed care or hospital environment Experience in international healthcare and/or air medical transport Experience in discharge planning and/or chart review International travel experience Demonstrated familiarity with InterQual criteria guidelines *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments. • Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • Collaborates with licensed care managers/leadership as needed or required. • 25- 40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Omatochi is actively seeking a compassionate and detail-oriented Care Manager to join our team. In this non-medical role, you will play a crucial part in coordinating and overseeing support services for our clients. The Care Manager will work closely with various stakeholders to ensure our clients receive the assistance and resources needed to improve their quality of life. The ideal candidate for this position is empathetic, organized, and possesses excellent communication skills. Responsibilities: Client Assessment and Support Planning: Conduct thorough assessments of clients' needs, considering their personal, social, and emotional requirements. Develop tailored support plans in collaboration with clients, their families, and relevant agencies. Coordinate with community resources to provide clients with appropriate services and assistance. Care Coordination and Advocacy: Serve as the main point of contact for clients, connecting them with relevant services and programs. Advocate for clients' needs, ensuring they receive timely and adequate support from various organizations and service providers. Monitor the progress of support plans and adjust them as necessary to meet clients' changing requirements. Client and Family Education: Educate clients and their families about available support services, community resources, and self-help techniques. Provide guidance on effective coping strategies and assist in developing life skills. Address clients' concerns and queries, building a trusting and supportive relationship. Documentation and Reporting: Maintain accurate records of client assessments, support plans, and interactions. Generate detailed reports on client outcomes, program effectiveness, and areas for improvement. Ensure compliance with organizational protocols and reporting requirements. Collaboration and Professional Development: Collaborate closely with community organizations, social workers, and relevant agencies to enhance the overall quality of client support. Participate in regular team meetings, training sessions, and workshops to stay informed about the latest developments in social services and care management. Pursue continuous professional development, seeking opportunities to expand knowledge and skills in the field of care management. Qualifications: Valid Drivers License and Vehicle Bachelor's degree in Social Work, Psychology, Counseling, Human Services, or a related field. Proven experience in non-medical care management, case management, or social services. Strong understanding of social service regulations, policies, and procedures. Excellent interpersonal skills, including active listening and empathy. Ability to work independently, prioritize tasks, and manage time efficiently. Proficiency in using case management software and other relevant tools. Benefits: Competitive salary and performance-based incentives. Comprehensive benefits package, including health, dental, and vision insurance. Generous paid time off, including vacation, personal days, and holidays. Ongoing professional development opportunities. Region and Travel: This is a position with a strong field-based component. While the incumbent will have flexibility to work from home, they are expected to travel extensively-approximately 50% to 80% of the time-within Santa Cruz County. This role requires a high level of mobility and availability to attend in-person visits, community events, and other field-based responsibilities throughout the geographic area of responsibility. Mileage Reimbursement / Vehicle Allowance: Travel-related expenses are reimbursed and whether a monthly stipend is provided for vehicle use. Scheduling Flexibility: Incumbent has autonomy over scheduling and is responsible for balancing field and administrative work. Omatochi is committed to creating an inclusive and diverse work environment. We encourage applications from candidates of all backgrounds and experiences.

About the role The April Parker Foundation is seeking compassionate, detail-oriented Care Managers (Generalists) to deliver Enhanced Care Management (ECM) and Community Supports (CS) services to Medi-Cal members with complex medical, behavioral, and social needs. You'll work directly with individuals experiencing housing insecurity, chronic illness, or behavioral-health challenges helping them navigate care, access community resources, and achieve stability in health and housing. This is a field-based / remote role ideal for professionals who value flexibility and meaningful impact. What you'll do Conduct outreach, assessments, and individualized care plans for ECM and CS members. Coordinate medical, behavioral, and social-service supports-including housing navigation and tenancy services. Complete timely documentation and progress tracking in APF systems. Provide in-person, telephonic, and virtual encounters based on member needs. Collaborate with health plans, community partners, and APF multidisciplinary teams. Maintain strict confidentiality and compliance with Medi-Cal, DHCS, and ILS guidelines. Compensation Base Salary (Straight-Time Pay) Salary is based on your caseload and is calculated using a simple, transparent formula: Each member = 2 paid hours per member per month (PMPM), at $25.00/hour ($50 PMPM) Your monthly salary increases as your caseload increases. Incentive Pay (Additional Earnings) You earn $40 per member per month for delivery qualified, on top of your base salary. Bringing total compensation to $90 PMPM, equivalent to $45/hour Reimbursements & Stipends Mileage reimbursement at the IRS rate $50/month phone stipend Reimbursement for approved work-related expenses Schedule Work hours are flexible and self-directed, provided Care Managers meet service delivery requirements and member availability Qualifications Minimum 2 years of experience in case management, care coordination, or related field Knowledge of Medi-Cal CalAIM programs, community resources, and social determinants of health Excellent documentation, organization, and communication skills Valid California Driver's License, auto insurance, and reliable transportation Preferred: Bachelor's degree or CHW certification; CA licensure (LCSW, LMFT, LPCC, RN, etc.)

Job Title: Patient Access Manager - Remote Job Country: United States (US) Here at Avanos Medical, we passionately believe in three things: * Making a difference in our products, services and offers, never ceasing to fight for groundbreaking solutions in everything we do; * Making a difference in how we work and collaborate, constantly nurturing our nimble culture of innovation; * Having an impact on the healthcare challenges we all face, and the lives of people and communities around the world. At Avanos you will find an environment that strives to be independent and different, one that supports and inspires you to excel and to help change what medical devices can deliver, now and in the future. Avanos is a medical device company focused on delivering clinically superior breakthrough solutions that will help patients get back to the things that matter. We are committed to creating the next generation of innovative healthcare solutions which will address our most important healthcare needs, such as reducing the use of opioids while helping patients move from surgery to recovery. Headquartered in Alpharetta, Georgia, we develop, manufacture and market recognized brands in more than 90 countries. Avanos Medical is traded on the New York Stock Exchange under the ticker symbol AVNS. For more information, visit *************** Essential Duties and Responsibilities: The Patient Access Manager is part of the Market Access, Reimbursement, and Medical Policy (MA&R) team. The MA&R team supports internal and external customers navigate through reimbursement nuances and barriers, the facilitation of authorizations and appeals, and collaborates with key opinion leaders, Specialty Societies, Government organizations, and payer decision makers to influence coverage via policy change in efforts to increase access to Avanos products. This role will primarily focus on the Avanos Pain Management and Recovery product portfolios, radiofrequency ablation products. The Patient Access Manager is a subject matter expert who will be directly responsible for development, oversight, and management of the Avanos Patient Access Program and team, and strategic initiatives in efforts to optimize access to Avanos Medical's Pain Management and Recovery portfolio products. Key Responsibilities: * Develops, implements, and manages the Avanos Patient Access Program and team members; including but not limited to program operations and processes to ensure superior support is provided, processes are followed, and compliance is maintained. * Hires and manages direct reports, including but not limited to performance reviews, time-off requests; ensuring superior support is provided, processes are followed, compliance is maintained, and direct reports are able to function in a productive, accurate, and efficient manner. * Is an expert level resource to provide on-the-job training for new hires, ongoing training, guidance, mentoring, and support to direct reports to resolve complex patient access issues and advance knowledge, foster career growth and expand team capabilities. * Performs frequent internal reviews and audits to ensure program operations remain aligned with strategic initiatives and direct reports are performing effectively as defined in program process and procedures documents, monitors case assignments to assess productivity, hiring needs, and serves as a back-up to ensure adequate staffing is available for all operations under the Patient Access Program. * Provides expert level acumen and support on patient access program processes and initiatives to support internal and external customers. Serves as the primary source of contact for addressing issues more complex than others serving on the Patient Access team may be required to know in an accurate, consistent, timely and compliant manner. * Analyzes program outcomes and recognizes trends/issues that hinder patient access, crafts strategic and tactical recommendations, and implements initiatives to adapt the program operations based on changing payer processes and requirements and to improve program outcomes and efficiency; including but not limited to program resources and collateral, processes, and procedures, as well as training documents and plans. * Fosters a strong alliance with the MA&R Team in the identification applicable market access, reimbursement, and payer coverage changes and/or trends at the customer, regional, and national levels that may impact patient access to Avanos products. Partners in the development and pull-through of strategic initiatives in efforts to increase access and neutralize barriers to Avanos products. * Aids in the development, preparation, and presentation of educational materials regarding patient access and program outcomes (e.g., training, workshops, and presentations). * Establishes professional relationships and maintains an effective communication network with the internal and external customer at multiple levels. * Participates in the operations of the Avanos Patient Access Program as needed; including but not limited to data entry, preparing, and facilitating appeals, collecting necessary documentation to fulfill payer requirements, and processing payer determinations. * Demonstrates uncompromised ethics while helping others understand legal and regulatory parameters related to patient access and adheres to Corporate Compliance programs and successfully participates in training and continuing education programs. * Performs other duties and projects as required/needed. Your qualifications Required: * Bachelors degree * Minimum of 3 years' experience within patient access, medical benefits, health insurance standards and authorization processes, and reimbursement with a comprehensive understanding of obtaining patient access of procedures across government and private payer environments specific to surgical procedure(s), and/or medical device(s), and/or DME, and/or biologic(s). * Minimum of 2 years' experience with direct oversight and management of the operations of a patient access program and team with a successful record of managing direct reports. * Advanced, in-depth knowledge of medical benefits, insurance standards, pre- service insurance authorization processes and requirements for reimbursement from government and private payers and ability to locate and interpret payer pre-service review requirements, policies, coverage determination making processes, etc. * Experience with educational presentations to external and internal customers with exemplary ability to provide superior support to internal and external customers and to expertly navigate through challenging situations. * Collaborative work ethic, exemplary leadership skills, excellent project and time management and communication (written and verbal) skills. * Proficient in using Microsoft PowerPoint, Excel, Windows, and Microsoft Office. Experience with data visualization software (e.g., Tableau) and CRM applications (e.g., Salesforce.com) or aptitude to learn such tools. General ability to learn and acclimate to new systems. * Working knowledge of compliance and regulatory mandates in medical device/technology environments; including but not limited to HIPAA, HITECH, ADVAMED, and Federal Statutes. Travel: Less than 10% The statements above are intended to describe the general nature and level of work performed by employees assigned to this classification. Statements are not intended to be construed as an exhaustive list of all duties, responsibilities and skills required for this position. Salary Range: The anticipated average base pay range for this position is $130,000.00 - $150,000.00. In addition, this role is eligible for an attractive incentive compensation program and benefits. In specific locations, the pay range may vary from the base posted. #LI-Remote Avanos Medical is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity or any other characteristic protected by law. IMPORTANT: If you are a current employee of Avanos or a current Avanos Contractor, please

Hello, how are you? Are you a LPN that is looking to improve the health of patients that have complex conditions? Do you live within a reasonable driving distance to St. Joseph, MO? Would you like to work from home and travel for the training/occasional meetings? If you answered yes to the above and have/are: Savvy with basic software/services such as email, word, excel, etc. Detail oriented to the point of annoying people because you pick up on things that others don't. Partial to helping people that are unappreciated, overlooked, and may not have any other types of support. A solid home/office environment that enables you to get the job done correctly whenever it needs to be done. Naturally competitive and want to win. YOU want to be the best and enjoy working with others who are the same. An active LPN license that is in good standing. ****1000 imaginary bonus points if you have long-term care, skilled nursing, assisted living, care management, or other experience working with patients who have chronic conditions.**** At SparroWell, we want to win by helping others get the best care possible. Our awesome team works with physicians, nurse practitioners, and other clinical team members that specialize in taking care of people with chronic illnesses. Our advanced care team also supports patients, families, as well as their caregivers to provide additional resources whenever needed. On any given day, our team is coordinating care, reviewing medications, auditing charts like a BOSS, collaborating with medical providers, and ultimately making a difference in the lives of patients we serve. We work from home but do occasionally meet in person for meetings and training on the latest requirements/guidelines. Go ahead, start the conversation by sending us your resume today. We will consider all applicants even though we prefer to work with nurses that have long-term care or post-acute experience. If you would like to learn more about our company, please visit us at **************************** Thank you for reviewing our opportunity and we look forward to hearing from you.

Salvo is looking for an experienced Nurse to support our chronic disease patients. In this role, you'll be a key contributor to the management and delivery of our care program, working closely with our patients, registered dietitians, and partner physicians to provide best-in-class care. You'll use your medical knowledge and product expertise to help our members navigate Salvo Health, assisting in medical and administrative tasks to keep the member moving through the program. Additionally, you'll help shape how we build and scale our product and process. Our ideal candidate is someone who enjoys the challenges of an early-stage start up, is eager to learn, process oriented, and has a patient-first mindset. What You Will do: Provide exceptional care, disease management and health education to patients Support goal setting for individual patients asynchronously to help them better manage their chronic conditions Create personalized action plans with guidelines to reduce or eliminate unwanted behaviors Help clients understand their motivations and create behavior change plans Conduct regular outreach to patients, based on their needs and preferences, to support engagement and elicit behavior change Coordinate with other clinical team members to provide an exceptional patient experience Develop and maintain professional, support-oriented working relationships with patients and team members Create and distribute health education materials to individual members as necessary Work with a cross-functional product team to develop and constantly improve our in-app patient experience Qualifications: 2+ year of experience as Licensed Practical Nurse or any Nursing license 2+ years of experience in patient-facing or customer-facing roles Compact state license required, additional licensing may be needed Bilingual (spanish speaking) a plus Excellent customer relation skills, as well as written and verbal communication skills Knowledge of medical terminology and proficiency of general medical office procedures Familiarity with digital applications like Slack, Coda, Google Workspace, etc. Strong analytical and proactive problem solving skills Self-motivated, results-oriented and strategic thinker Personal passion for health and wellness topics Must be authorized to work in the United States Experience working in telehealth or healthcare startup environment preferred Bonus: Experience working in GI, weight management, and/or with anti-obesity medications such as GLP-1s Salvo is a new approach to help millions of Americans facing chronic health conditions, centered on chronic gut health and metabolic conditions from IBS to obesity. Our patients are assigned a “whole patient” care team and have seven day a week access to app-based care, using Remote Patient Monitoring (“RPM”) to bill under the patient's insurance. This is a major step forward to go beyond episodic appointments to continuous care at home, and deliver interdisciplinary wraparound care in partnership with the patient's existing local doctor. Salvo is backed by leading health care investors from innovators like Livongo, Ro, Ginger, Forward, Brightline, Tia, and others. Salvo care draws on expertise from Board-certified specialty physicians, registered dietitians, nurses, psychologists, and therapists who have developed our evidence-based protocols, for a personalized, multi-month journey to better health. Salvo is the first to bring a scalable and tech-enabled, more integrative approach to these chronic conditions, going beyond treating only the symptoms in order to identify and address the root causes of chronic illness. Salvo offers a competitive salary and health benefits, a remote work environment, flexible time-off, a larger sense of mission, and professional development and entrepreneurial opportunities. Working alongside a bunch of super talented and friendly people, in a culture that likes to drive constant innovation, and marked by relentless curiosity and a sense of empathy. Salvo is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Insight Global is hiring for a Remote Care Manager to support our micro clinic operations in Raleigh, NC. You will work in a virtual setting with providers, paramedics, and patients to partner in the care continuum process. You will lead the clinical onboarding of new contracts, handle referrals & authorizations, and ensure seamless communication with all stakeholders. Responsibilities will include: · Develop and monitor care plans in collaboration with multiple providers, adjusting as needed · Follow up on interventions to prevent unnecessary ER visits and hospital admissions · Serve as the primary liaison between patients, families, and healthcare staff to ensure seamless communication · Navigate multiple healthcare platforms including EHRs, payer portals, billing software, and patient messaging systems · Ensure timely and accurate documentation across systems to support care continuity and compliance · Verify provider participation, coverage, and pre-authorization requirements with insurance administrators and healthcare facilities · Optimize client contracts and referral workflows to enhance scalability and efficiency in care coordination · Schedule and manage appointments, follow-ups, and referrals to specialists and services · Educate patients on conditions, medications, and treatment plans to promote understanding and adherence · Track patient progress and address barriers to treatment plan compliance We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to ********************.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: **************************************************** Skills and Requirements · RN Licensure or Paramedic Licensure in North Carolina · Minimum of 3 years of experience in care coordination (care or case management) · Strong knowledge of insurance benefits, prior authorizations, and referral management · Proficiency with EMR/EHR systems, payer portals, and standard office software (60% of role) · Strong communicational & organizational skills - ability to work efficiently with a team

Do you dream of a role where you can connect with people and transform lives - all while working remotely? We're looking for Care Managers who thrive on building relationships with families with adult neurodivergent children - understanding their goals and helping them access specialized resources. Join us and transform the lives of hundreds of adults with developmental disabilities as you scale with a high-growth, innovative company. At NeuroNav, we believe everyone deserves the opportunity to make their own choices and shape their story, regardless of disability. Our mission is to enhance the quality of life for adults with developmental disabilities through simplicity and choice. We specialize in helping families navigate a specific California state funded program called Self-Determination, which offers more creative and custom choice as to how to leverage state funds. This is a life-changing program and you will be the conductor, breaking down barriers for your client and ensuring his or her success. As one of our virtual Care Managers (the heart and soul of our team called “Navigators” internally), you'll create custom client plans and guide families in a step-by-step process to enter and maintain participation in this program. In this remote role, you will be able to leverage your creativity, kindness and relational skills in social work, case management, and service coordination to transform your clients' lives and help them write the stories they dream of. About NeuroNav Founded at Stanford in 2020, with support from the Stanford Innovation Fellowship, Pear VC and Core Innovation Capital, NeuroNav drives new vision and change in disability by creating personalized care plans and connecting our neurodivergent clients with virtual Care Navigators who help manage their benefits. Last year, we supported hundreds of individuals in accessing life-changing services, and we're on track to quadruple our impact next year. Responsibilities include: Person-centered Planning - you will be trained in a special facilitation framework to capture your client's unique strengths, goals, needs and desired outcomes and align them to a plan unique to them. Budget & Spending Management - you will help translate personalized plans into concrete support needs and advocate for those needs to local budget authorities. Project Management - you will be the driver that holds the process together and guides the client and other partner organizations. Service Provider Access - you will leverage NeuroNav's proprietary resources to search for and assist providers in implementing person-centered plans throughout the year. Special Projects - you will contribute your talent and insights from working with clients into key company strategy and initiatives each quarter. What You'll Bring Bachelor's Degree or equivalent work experience Social Work or case management experience in the disability or social services field Client-facing experience managing multiple relationships at one time Excellent written and verbal communication skills Must have computer, reliable high-speed internet connection, and a quiet work environment Fluent in Spanish and bilingual (strongly preferred) Experience in a performance-based culture with metrics attainment goals (preferred) Experience serving in the developmental disability field (preferred) Experience with Microsoft Office & Google Suite (preferred) Experience in person-centered planning and in the California developmental disability system (preferred) Experience in Case management: 2 years (Preferred) Benefits We believe in supporting our employees' well-being and work-life balance as part of our culture and offer the following benefits: Remote first - Ability to work from home Health, vision and dental insurance 401(k) 14 Paid Time Off (PTO) days per year 7 sick or flex days per year Annual company retreat Salary: $50-60k per year (depending on experience)

This position consists of weekly in-person Care Management visits with the client, coordination with PCP and telephonic contact to ensure adherence to treatment plan. Also must be available to answer questions that the client may have between visits. During the visit CM will gather information and educate the patient on his or her disease management, medication administration, and home safety in order to the client remain safely at home. CM will assist patient and/or family member to connect with other needed resources such as meals, transportation to PCP, and insuring that all prescribed medications are in the home. At all times the Director of Healthcare Operations is available as a resource to CM. Requirements Must have at least 1 year verifiable experience as a RN, LPN or Social Worker Must have an active professional license in your state. Must have a good driving record, auto insurance, a reliable vehicle Must have internet access for visit and assessment logging Must be a dependable person The applicant must not have Disciplinary Actions against their professional license or be listed in the List of Excluded Individuals/Entities Search Responsibilities The RN, LPN or Social Worker will also be required to enter all assessment and visit information into the online system within 24 hours of the visit. Upon hire and prior to the first visit, a short online training session and webinar will need to be completed. You will be required to visit the client once a week, 4 times a month on going. Flexible schedule. Work from home.

We are a rapidly growing healthcare organization dedicated to supporting patients living with chronic conditions. Our mission is to deliver personalized, high-quality care that empowers individuals to take control of their health with confidence. Through a fully remote model, our Care Managers guide patients through their care journeys-educating, advocating, and coordinating support that leads to better outcomes and smoother day-to-day management. We're looking for a motivated Care Manager who is eager to apply their medical knowledge in a hands-on, patient-facing role. This position is ideal for someone with a healthcare diploma, training, or any form of medical education or clinical exposure who wants to put that foundation to meaningful use. You'll act as the central point of contact for patients, helping them understand their conditions, navigate care plans, and stay on track with treatment while working alongside providers, social workers, and community partners. Key Responsibilities: Monitor and coordinate care plans by tracking progress, adjusting interventions, and maintaining consistent patient support. Provide clear, accessible education about chronic conditions, treatment options, and lifestyle strategies. Coordinate appointments, follow-ups, and referrals, ensuring smooth connection to appropriate providers. Maintain accurate patient records, including health information, insurance details, and supporting documentation. Respond promptly and empathetically to patient questions, concerns, and urgent needs. Partner with care teams to develop, assess, and refine patient-centered interventions. Collaborate with behavioral health, disease management, home health, social work, and community organizations for holistic care. Ideal Qualities and Skills: Strong verbal and written communication skills and the ability to simplify medical information for patients. Fluency in Spanish (spoken and written), with the ability to support Spanish-speaking patients and families. Solid problem-solving instincts and a proactive approach to anticipating patient needs. Organized, detail-oriented, and reliable in managing patient caseloads and documentation. Comfortable prioritizing tasks and managing time effectively in a remote environment. Collaborative mindset with genuine care for patient well-being. Healthcare diploma or equivalent preferred. Any level of medical or healthcare experience-clinical rotations, internships, coursework, or similar-is welcomed. Compensation: Competitive hourly rate of $15-$20 per hour, based on experience and qualifications (Full Time). A supportive remote environment with opportunities for professional growth and development. Fully Remote opportunity.

Advance Hospice Care. Lead Clinical Excellence. Inspire Compassionate Teams. We are seeking a dedicated Patient Care Manager to join our hospice team. Reporting directly to the Executive Director or Administrator, you will oversee patient care activities to ensure the delivery of high-quality, compliant hospice services. This leadership role involves managing clinical operations, coordinating care, and developing staff to uphold the highest standards of patient care and regulatory compliance. As a Hospice Patient Care Manager, You Will: Oversee and direct patient care services to ensure the delivery of high-quality hospice care Manage visit scheduling, including reassigned, missed, declined, or rescheduled visits-making decisions based on clinical judgment and priority Triage incoming phone referrals and medical concerns in a timely, compassionate, and professional manner Lead or facilitate Interdisciplinary Group (IDG) meetings, including presenting patient updates, reviewing charts, coordinating care plans, and documenting minutes Serve as a mentor, trainer, and clinical support to associates, supporting development, performance, and compliance Ensure all care delivery meets federal, state, and local regulatory standards, as well as company policies and procedures Support performance improvement initiatives, quality assessments, and operational efficiencies within your location About You Qualifications - What You'll Bring: Current RN license in the state of employment Graduate of an accredited nursing program Minimum of 3 years of direct patient care experience, including 2 years in a hospice or home-based care setting Demonstrated ability to apply hospice principles, industry standards, and regulatory compliance (Medicare, Medicaid, JCAHO, ACHC) Knowledge and compassion for terminally ill patients and their families Ability to lead a diverse care team while adapting to the emotional and clinical needs of patients from various backgrounds Strong interpersonal, organizational, and leadership skills Competency in clinical documentation and technology systems Preferred Qualifications (Not Required): Bachelor of Science in Nursing (BSN) Previous leadership, team management, or supervisory experience in hospice or home health Familiarity with EMR systems and telehealth platforms Certification in Hospice and Palliative Nursing (CHPN) We Offer Benefits for All Associates (Full-Time, Part-Time & Per Diem): Competitive Pay 401(k) with Company Match Career Advancement Opportunities National & Local Recognition Programs Teammate Assistance Fund Additional Full-Time Benefits: Medical, Dental, Vision Insurance Mileage Reimbursement or Fleet Vehicle Program Generous Paid Time Off + 7 Paid Holidays Wellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care) Education Support & Tuition Assistance (ASN to BSN, BSN to MSN) Free Continuing Education Units (CEUs) Company-paid Life & Long-Term Disability Insurance Voluntary Benefits (Pet, Critical Illness, Accident, LTC) Ready to Join a Team That Cares? Apply today and help us lead the way in delivering hospice care that truly matters. Legalese This is a safety-sensitive position Employee must meet minimum requirements to be eligible for benefits Where applicable, employee must meet state specific requirements We are proud to be an EEO employer We maintain a drug-free workplace Compensation may vary within the salary range provided based on several factors including but not limited to a candidate's location, experience, education, skills, licensure, certifications and department equity. Gentiva provides associates with a comprehensive benefits and total rewards package, of which base pay is just one piece. Salary Range: $83,795 - $104,745 Location Gentiva Hospice Our Company At Gentiva, it is our privilege to offer compassionate care in the comfort of wherever our patients call home. We are a national leader in hospice care, palliative care, home health care, and advanced illness management, with nearly 600 locations and thousands of dedicated clinicians across 38 states. Our place is by the side of those who need us - from helping people recover from illness, injury, or surgery in the comfort of their homes to guiding patients and their families through the physical, emotional, and spiritual effects of a serious illness or terminal diagnosis. Hospice care: Gentiva Hospice, Emerald Coast Hospice Care, Heartland Hospice, Hospice Plus, New Century Hospice, Regency SouthernCare, SouthernCare Hospice Services, SouthernCare New Beacon Palliative care: Empatia Palliative Care, Emerald Coast Palliative Care Home health care: Heartland Home Health Advanced illness management: Illumia Health With corporate headquarters in Atlanta, Georgia, and providers delivering care across the U.S., we are proud to offer rewarding careers in a collaborative environment where inspiring achievements are recognized - and kindness is celebrated.

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

Animal Care Manager Our Animal Care Managers bring a high level of knowledge and understanding regarding the importance of quality care for pets. They ensure all pets in our kennels are provided the best care possible and are dedicated to supporting the company's mission to match the right pet with the right customer and meet the needs of both. If you have a passion for caring for animals, like to have fun, and would enjoy working for a great company that values the contributions of others, Petland is the place for you! WHY PETLAND IS A GREAT PLACE TO WORK: Petland is more than a job, it's a pet loving community. We're looking for people with an unwavering love for animals who want to build or advance their career in a fun and rewarding environment. Imagine coming to work every day knowing that you help create lasting connections between pets and their new families. Turn your pet passion into a fulfilling career at Petland! Watch the Petland career video here: ************************************** POSITION DUTIES AND RESPONSIBILITIES: Dedicated to upholding the Petland Kennel Department Mission, Vision and Value Statement. Dedication to providing excellent care for the pets at Petland by leading kennel personnel to meet Petland's mission of caring for each animal while maintaining a safe and sanitary environment for our pets. Assists with kennel staffing and performs various management tasks that best ensures the success of store associates. Ensures that all opening, daily and closing procedures are followed in the kennel through procedural checklists. Maintains a strong relationship with the consulting Veterinarian to ensure excellent care of the pets. Assists Veterinarian(s) with puppy and kitten examinations and provides care and medications as prescribed. Helps Petland store leadership with the implementation of various community or customer programs (preparing Petland pets for visits to schools, nursing homes and other community outings, etc.) REQUIRED SKILLS: Pet sensitivity Organizational skills Effective communication skills Attention to detail Animal care experience Self-motivated Teamwork oriented Problem solving skills Strong work ethic REQUIRED EDUCATION AND/OR TRAINING: Associate degree (AA) or equivalent from a two-year college or technical school, six months to one-year related experience and/or training or equivalent combination of education and experience preferred. PHYSICAL DEMANDS AND WORK ENVIRONMENT: Standing -Continually required to stand Walking -Continually required to walk Sitting - Occasionally required to sit Travelling - Occasionally required to travel Finger Dexterity - Continually required to utilize hand and finger dexterity Climb, Bend, Balance, Stoop, Kneel or Crawl - Frequently required to climb, balance, bend, stoop, kneel or crawl Talking/Hearing - Continually required to talk or hear Visual Accuity - Continually utilize visual acuity to operate equipment, read technical information, and/or use a keyboard Lifting/Pushing/Carrying - Occasionally required to lift more than 50 lbs. at a time with frequent lifting, pushing, or carrying of up to 30 lbs. EEO Statement: Petland is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, pregnancy, national origin, age, mental or physical disabilities, military or veteran status, sexual orientation, or gender identity status. The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Those applicants requiring reasonable accommodation to the application and/or interview process should notify Petland's Department of Human Resources.

Benefits: Job you will love Fulfilling work Rewarding Career Supportive Environment Make a difference for your clients In Demand The Care Manager is responsible for providing quality professional care management services to all clients and their responsible parties. Our objective is to assist our clients in managing and navigating challenges in aging as well as Adults with physical and mental disabilities and providing the highest quality of life. This includes: Care Coordination Managing home health aides Medical oversight Interfacing with medical personnel Advocacy, information and referrals Qualifications: Professional and positive approach, commitment to customer service Self-motivated and work with own initiative Strong in building relationships, team player and able to communicate at all levels Recognizes industry trends and problem solves Respectful of company and client confidentiality; any violation of company or client confidence is immediate grounds for dismissal. Personalized and compassionate service - focusing on the individual client's wants and needs. Ability to provide non-directive guidance and facilitate constructive relationships. Ability to ensure inappropriate placements, duplication of services, and unnecessary hospitalizations are avoided. Manage time efficiently. Ability to provide coordinated communication between family members, doctors and other professionals, and service providers. This is a remote position. Aging Life Care Professionals offer a holistic, client-centered approach to caring for older adults or others facing ongoing health challenges. Working with families, the expertise of Aging Life Care Professionals provides the answers at a time of uncertainty. Their guidance leads families to the actions and decisions that ensure quality care and an optimal life for those they love, thus reducing worry, stress and time off of work for family caregivers through: Assessment and monitoring Planning and problem-solving Education and advocacy Family caregiver coaching This business is independently owned and operated. Your application will go directly to the business, and all hiring decisions will be made by the management. All inquiries about employment at this business should be made directly and not to Aging Life Care Association.

Please note that this job posting is for an evergreen position and does not represent an active or current vacancy within our organization. We continuously accept applications for this role to build a talent pool for future opportunities. While there may not be an immediate opening, we encourage qualified candidates to submit their resumes for consideration when a suitable position becomes available. Chronic Care Manager Location: Remote Join our mission to help transform healthcare delivery from reactive, episodic care to proactively managed patient care that prevents live-changing problems before they happen for patients with two or more chronic conditions. We believe every patient with chronic disease deserves consistent check-ins, follow-up, and support. The position of the Nurse Chronic Care Coordinator, Remote will perform telephonic encounters with patients on behalf of our partners each month and develops detailed care plans within our care plan templates in the electronic health record. This begins as an Independent 1099 Contractor position but offers the potential to reach full-time W2 employment (with employee benefits). Harris CCM is seeking Nurses to work part-time from their home office while complying with HIPAA privacy laws. You will set your own hours and will not be held to a daily work hour schedule. You will be contracted to work a minimum of 20hrs/wk. Harris CCM wants its team members to have the flexibility to balance their work-life with their home life. Part-time team members will typically need to dedicate an average of 20-30 hours per week to care for their assigned patients. This unique business model allows you to choose what days and what hours of the day you dedicate to care for your patients. The Care Coordinator will be assigned a patient panel based on skill and efficiency level and is expected to carry a patient panel of a minimum of 100 patients per calendar month. Care Coordinators will be expected to complete encounters on 90 percent of the patients they are assigned. Harris CCM utilizes a productivity-based pay structure and pays $10.00 per completed patient encounter up to 99 encounters/month, $10.25/encounter from 100-149 encounters/month, $12/encounter from 150-199 encounters/month, $14/encounter from 200-249 encounters/month, and $16/encounter for >250 encounters/month. Payment tier increases require 3 months consistency to achieve. A patient encounter will take a minimum of 20 minutes (time is cumulative). What your impact will be: The role of the Care Coordinator is to abide by the plan of care and orders of the practice. Ability to provide prevention and intervention for multiple disease conditions through motivational coaching. Develops a positive interaction with patients on behalf of our practices. Improve revenue by creating billable CCM episodes, increasing visits for management of chronic conditions. Develops detailed care plans for both the doctors and patients. The care plans exist for prevention and intervention purposes. Understand health care goals associated with chronic disease management provided by the practice. Attend regularly scheduled meetings (i.e., Bi-Monthly Staff Meetings, monthly one on one's, etc.). These “mandatory” meetings will be important to define the current scope of work. What we are looking for: Graduate from an accredited School of Nursing. (LPN, LVN, RN, BSN, etc.) Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no disciplinary actions noted A minimum of two (2) years of clinical experience in a Med/Surg, Case Management, and/or home health care. Hands-on experience with Electronic Medical Records as well as an understanding of Windows desktop and applications (MIcrosoft Office 365, Teams, Excel, etc), also while being in a HIPAA compliant area in home to conduct Chronic Care Management duties. Ability to exercise initiative, judgment, organization, time-management, problem-solving, and decision-making skills. Skilled in using various computer programs (If you don't love computers, you won't love this position!) High Speed Internet and Desktop or Laptop computer (Has to be operation system of Windows or Mac) NO Chromebooks Excellent verbal, written and listening skills are a must. What will make you stand out: Quickly recognize condition-related warning signs. Organized, thorough documentation skills. Self-directed. Ability to prioritize responsibilities. Demonstrated time management skills. Clear diction. Applies exemplary phone etiquette to every call. Committed to excellence in patient care and customer service. What we offer: Contract position with opportunity to become a full-time position, to include benefit options (Medical, Dental, Vision, 401K, Life). Streamline designed technology for your Chronic Care operations Established and secure company since 1976, providing critical software solutions for many verticals in countries ranging from North America, Europe, Asia, and Australia. Core Values that unite and guide us Autonomous and Flexible Work Environments Opportunities to learn and grow Community Involvement and Social Responsibility About us: For over 20 years GEMMS has been the leader in Cardiology Specific EHR technology. The product was developed in a “living laboratory” of a large Cardiology Enterprise with over 40 physicians in 28 locations. For single physician offices to large cardiovascular centers that include a diagnostic centers, ambulatory surgical center, and peripheral vascular offerings. When physicians and Administrators evaluate GEMMS ONE, they are often impressed with the vast clinical cardiovascular knowledge content and operational aspects found in GEMMS ONE. GEMMS ONE EHR provides a rich array of functionality spanning the entire cycle of patient care. With everything from a patient portal to e-prescribing to clinical documentation to practice management including cardiovascular specific quality measurements and MIPS patient dashboard. GEMMS ONE EHR System provides all the medical records software tools needed to complete your daily tasks in the most efficient way possible. GEMMS ONE is a fully interoperable and integrated application that allows “real time” merging of clinical processes and revenue cycle management. It also can seamlessly connect to external revenue cycle management programs that might be used in larger enterprises so that you can get the efficiency of Cardiovascular Clinical workflow while supporting the revenue cycle requirements of larger enterprises. Complying with governmental regulations and payer requirements will be simplified, while enhancing your operational and financial performance.

LOCATION: Remote - must live in or near Rowan County, North Carolina. The person in this position must maintain residency in North Carolina or within 40 miles of the North Carolina border. This position requires travel. GENERAL STATEMENT OF JOB The Care Manager is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members and recipients (“members”) to ensure that these individuals receive appropriate assessment and services. The Care Manager works with the member and care team to alleviate inappropriate levels of care or care gaps through assessment, multidisciplinary team care planning, linkage and/or coordination of services needed by the member across the MH, SU, intellectual/ developmental disability (“I/DD”), traumatic brain injury (“TBI”) physical health, pharmacy, long-term services and supports (“LTSS”) and unmet health-related resource needs networks. Care Managers support and may provide transition planning assistance to state, and community hospitals and residential facilities and track individuals discharged from facility settings to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalization. This is a mobile position with work done in a variety of locations, including members' home communities. The Care Manager also works with other Vaya staff, members, relatives, caregivers/ natural supports, providers, and community stakeholders. As further described below, essential job functions of the Care Manager include, but may not be limited to: Utilization of and proficiency with Vaya's Care Management software platform/ administrative health record (“AHR”) Outreach and engagement Compliance with HIPAA requirements, including Authorization for Release of Information (“ROI”) practices Performing Health Risk Assessments (HRA): a comprehensive bio-psycho-social assessment addressing social determinants of health, mental health history and needs, physical health history and needs, activities of daily living, access to resources, and other areas to ensure a whole person approach to care Adherence to Medication List and Continuity of Care processes Participation in interdisciplinary care team meetings, comprehensive care planning, and ongoing care management Transitional Care Management Diversion from institutional placement This position is required to meet NC Residency requirements as defined by the NC Department of Health and Human Services (“NCDHHS” or “Department”). This position is required to live in or near the counties served to effectively deliver in-person contacts with members and their care teams. ESSENTIAL JOB FUNCTIONS Assessment, Care Planning, and Interdisciplinary Care Team: Ensures identification, assessment, and appropriate person-centered care planning for members. Links members with appropriate and necessary formal/ informal services and supports across all health domains (i.e., medical, and behavioral health home) Meets with members to conduct the HRA and gather information on their overall health, including behavioral health, developmental, medical, and social needs. Administer the PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings within their scope based on member's needs. The Care Manager uses these screenings to provide specific education and self-management strategies as well as linkage to appropriate therapeutic supports. The assessment process includes reviewing and transcribing member's current medication and entering information into Vaya's Care Management platform, which triggers the creation of a multisource medication list that is shared back with prescribers to promote integrated care. Supports the care team in development of a person-centered care plan (“Care Plan”) to help define what is important to members for their health and prioritize goals that help them live the life they want in the community of their choice. Ensure the Care Plan includes specific services to address mental health, substance use, medical and social needs as well as personal goals Ensure the Care Plan includes all elements required by NCDHHS Use information collected in the assessment process to learn about member's needs and assist in care planning Ensure members of the care team are involved in the assessment as indicated by the member/LRP and that other available clinical information is reviewed and incorporated into the assessment as necessary Work with members to identify barriers and help resolve dissatisfaction with services or community-based interventions Reviews clinical assessments conducted by providers and partners with Care Manager - LP and Care Manager Embedded - LP for clinical consultation as needed to ensure all areas of the member's needs are addressed. Help members refine and formulate treatment goals, identifying interventions, measurements, and barriers to the goals Ensures that member/legally responsible person (“LRP”) is/are informed of available services, referral processes (e.g., requirements for specific service), etc. Provides information to member/LRP regarding their choice of service providers, ensuring objectivity in the process Works in an integrated care team including, but not limited to, an RN (Registered Nurse) and pharmacist along with the member to address needs and goals in the most effective way ensuring that member/LRP have the opportunity to decide who they want involved Supports and may facilitate care team meetings where member Care Plan is discussed and reviewed Solicits input from the care team and monitor progress Ensures that the assessment, Care Plan, and other relevant information is provided to the care team Reviews assessments conducted by providers and consults with clinical staff as needed to ensure all areas of the member's needs are addressed Updates Care Plans and Care Management assessment at a minimum of annually or when there is a significant life change for the member Supports and assists with education and referral to prevention and population health management programs. Works with the member/LRP and care team to ensure the development of a Care Management Crisis Plan for the member that is tailored to their needs and desires, which is separate and complementary to the behavioral health provider's crisis plan. Provides crisis intervention, coordination, and care management if needed while with members in the community. Supports Transitional Care Management responsibilities for members transitioning between levels of care Coordinates Diversion efforts for members at risk of requiring care in an institutional setting Consults with care management licensed professionals, care management supervisors, and other colleagues as needed to support effective and appropriate member care. Collaboration, Coordination, Documentation: Serves as a collaborative partner in identifying system barriers through work with community stakeholders. Manages and facilitates Child/Adult High-Risk Team meetings in collaboration with DSS, DJJ, CCNC, school systems, and other community stakeholders as appropriate. Works in partnership with other Vaya departments to identify and address gaps in services/ access to care within Vaya's catchment. Participates in cross-functional clinical and non-clinical meetings and other projects as needed/ requested to support the department and organization. Participates in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs, providing support to other CMs (Care Manager) and receiving support and feedback regarding CM interventions for clients' medical, behavioral health, intellectual /developmental disability, medication, and other needs. Works with Care Manager - LP and Care Manager Embedded - LP in participating in other high risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system. Monitors provision of services to informally measure quality of care delivered by providers and identify potential non-compliance with standards. Ensures the health and safety of members receiving care management, recognize and report critical incidents, and escalate concerns about health and safety to care management leadership as needed. Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other stakeholders. Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues. Supports and assists members/families on services and resources by using educational opportunities to present information. Verifies member's continuing eligibility for Medicaid, and proactively responds to a member's planned movement outside Vaya's catchment area to ensure changes in their Medicaid county of eligibility are addressed prior to any loss of service. Proactively and timely creates and monitors documentation within the AHR to ensure completeness, accuracy and follow through on care management tasks. Maintains electronic AHR compliance and quality according to Vaya policy. Works with Care Manager - LP and Care Manager Embedded - LP to ensure all clinical and non-clinical documentation (e.g. goals, plans, progress notes, etc.) meet all applicable federal, state, and Vaya requirements, including requirements within Vaya's contracts with NCDHHS. Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies. Other duties as assigned. KNOWLEDGE, SKILLS, & ABILITIES Ability to express ideas clearly/concisely and communicate in a highly effective manner Ability to drive and sit for extended periods of time (including in rural areas) Effective interpersonal skills and ability to represent Vaya in a professional manner Ability to initiate and build relationships with people in an open, friendly, and accepting manner Attention to detail and satisfactory organizational skills Ability to make prompt independent decisions based upon relevant facts. Well-developed capabilities in problem solving, negotiation, arbitration, and conflict resolution, including a high level of diplomacy and discretion to effectively negotiate and resolve issues with minimal assistance. A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change Thorough knowledge of standard office practices, procedures, equipment, and techniques and intermediate to advanced proficiency in Microsoft office products (Word, Excel, Power Point, Outlook, Teams, etc.), and Vaya systems, to include the care management platform, data analysis, and secondary research Understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) within their scope and have considerable knowledge of the MH/SU/IDD/TBI service array provided through the network of Vaya providers. Experience and knowledge of the NC Medicaid program, NC Medicaid Transformation, Tailored Plans, state-funded services, and accreditation requirements are preferred. Ability to complete and maintain all trainings and proficiencies required by Vaya, however delivered, including but not limited to the following: BH I/DD Tailored Plan eligibility and services Whole-person health and unmet resource needs (ACEs, trauma-informed care, cultural humility) Community integration (independent living skills; transition and diversion, supportive housing, employment, etc.) Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc.) Health promotion (common physical comorbidities, self-management, use of IT, care planning, ongoing coordination) Other care management skills (transitional care management, motivational interviewing, person-centered needs assessment and care planning, etc.) Serving members with I/DD or TBI (understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc.) Serving children (child-and family-centered teams, Understanding the “System of Care” approach) Serving pregnant and postpartum women with SUD or with SUD history Serving members with LTSS needs (Coordinating with supported employment resources Job functions with higher consequences of error may be identified, and proficiency demonstrated and measured through job simulation exercises administered by the supervisor where a minimum threshold is required of the position. EDUCATION & EXPERIENCE REQUIREMENTS Bachelor's degree required, preferably in a field related to health, psychology, sociology, social work, nursing or another relevant human services area. Serving members with BH conditions: Two (2) years of experience working directly with individuals with BH conditions Serving members with LTSS needs Two (2) years of prior Long-term Services and Supports (LTSS) and/or Home Community Based Services (HCBS) coordination, care delivery monitoring and care management experience. This experience may be concurrent with the two years of experience working directly with individuals with BH conditions, an I/DD, or a TBI, described above --If graduate of a college or university with a Bachelor's degree in Human Services, then incumbent must have two years of full-time accumulated experience in mental health with population served. --If graduate of a college or university with a Bachelor's degree is in field other than Human Services, then incumbent must have four years of full-time accumulated experience in mental health with population served. --If a graduate of a college or university with a Bachelor's Degree in Nursing and licensed as RN, then incumbent must have four years of full-time accumulated experience in mental health with population served. Experience can be before or after obtaining RN licensure. --If graduate of a college or university with a Master's level degree in Human Services, although only one year of experience is needed to reach QP status, the incumbent must still have at least two years of full-time accumulated experience in mental health with the population served *Must meet the criteria of being a North Carolina Qualified Professional with the population served in 10A NCAC 27G .0104 Licensure/Certification Required: If Incumbent has a Bachelor's degree in nursing and RN, incumbent must be licensed by the North Carolina Board of Nursing to practice in the State of North Carolina. Preferred work experience: Experience working directly with individuals with I/DD or TBI PHYSICAL REQUIREMENTS Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists, and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work. Ability to drive and sit for extended periods of time (including in rural areas) RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border. SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation. DEADLINE FOR APPLICATION: Open Until Filled APPLY: Vaya Health accepts online applications in our Career Center, please visit ****************************************** Vaya Health is an equal opportunity employer.

The Clinic Manager II assumes primary responsibility for overseeing clinical and administrative functions of capital and operating budgets, patient registration, billing, clinical information systems, management of clinical and administrative staff and clinic marketing and planning. This position is responsible for managing performance for Caregiver Engagement, Service Excellence, Quality & Safety and Stewardship. Responsible for multiple small practices or a large complex practice with a score between 7 and 12 on the Manger Trigger Tool (see below). This position ensures compliance with all regulatory and accreditation standards, financial performance and clinic policies. Decisions are made independently or in collaboration with others. This position has patient contact, has access to confidential information and functions under the direct supervision of a Director. Minimum Qualifications: Required Educational Degree: Bachelor's Degree Major/Area of Concentration: Any Effective 01/01/2021 for all current Managers and New Hires Bachelor's degree required within 5 yrs (3 yrs if you already posses an Associate's degree) Preferred Education: Bachelor's Degree in Business Administration or related field preferred Required Certifications, Credentials and Licenses: De-escalation training within 6 months. Required Experience: 2 - 4 years of practice management experience with progressive responsibility Job Specific Essential Functions: Provide operational leadership and oversight of one or more high-volume or multi-specialty clinics. Participate in recruitment, hiring, onboarding, training, and professional development of staff. Direct, supervise, and evaluate performance of clinical and administrative staff. Partners with hospital leaders to oversee outpatient ancillary operations, when applicable. Engage physicians and staff through communication of priorities, delegation of clinic tasks, and accountability to the achievement of goals. Utilize huddles and rounding to facilitate problem solving, communication from AHS system meetings, and identification of clinic concerns/issues. Manage processes in the clinic through implementation of SOP's, auditing, correction and suggestions for continuous quality improvement. Develop plans for improved provider productivity by working with providers on waste elimination, template redesign, optimization of outrotations, improving fill rate, and marketing / sales interfaces where appropriate. Responsible for metric tracking, root cause analysis, and improvement to meet or exceed budgeted quality, service, volumes and expenses. Ensure all provider encounters are captured, documented, locked in a timely manner and coded for comprehensive revenue cycle process. Responsible for completion of cash posting, financial deposits, A/R tracking and improvement toward MGMA service specific days in A/R and reporting of variances Act as liaison for providers to answer questions, communicate concerns to system, and solve day to day issues. Holds clinic team accountable for adherence to leadership and provider compact expectations of communication / behavior in delivery of care for optimal service to patients. Adhere to AHS, local, state and national legal and regulatory compliance requirements through ongoing clinic audit reviews and corrective action Benefits for Eligible Caregivers: Paid Time Off Retirement Plan Medical Insurance Tuition Reimbursement Work-Life Balance About Adena Heart and Vascular: The Adena Heart and Vascular Institute provides advanced, comprehensive care for heart, vascular, and thoracic conditions through cutting-edge technology and a skilled team of specialists. The institute emphasizes personalized treatment plans, collaboration among experts, and a focus on both immediate and long-term health. A key feature is our new hybrid operating room, which integrates advanced imaging and surgical capabilities to perform complex, minimally invasive cardiovascular procedures-such as TEVAR and EVAR-with a multidisciplinary team. This approach reduces complications and recovery times, allowing patients to receive high-quality, innovative care close to home. About Adena Health: Adena Health is an independent, not-for-profit and locally governed health organization that has been “called to serve our communities” for more than 125 years. With hospitals in Chillicothe, Greenfield, Washington Court House, and Waverly, Adena serves more than 400,000 residents in south central and southern Ohio through its network of more than 40 locations, composed of 4,500 employees - including more than 200 physician partners and 150 advanced practice provider partners - regional health centers, emergency and urgent care, and primary and specialty care practices. A regional economic catalyst, Adena's specialty services include orthopedics and sports medicine, heart and vascular care, pediatric and women's health, oncology services, and various other specialties. Adena Health is made up of 341 beds, including 266-bed Adena Regional Medical Center in Chillicothe and three 25-bed critical access hospitals-Adena Fayette Medical Center in Washington Court House; Adena Greenfield Medical Center in Greenfield; and Adena Pike Medical Center in Waverly.