Registered Nurse Case Manager jobs at Rising Medical Solutions - 528 jobs

servicing Oakland and surrounding areas) Feel the Value of Excellence by providing quality medical case management for injured workers, coordinating appropriate care, making recommendations, and professionally communicating with insurance carriers, healthcare providers, ancillary vendors, employers, and attorneys. Make a difference by driving to and attending medical appointments in-person. Complete prompt and thorough documentation and qualify for bonus compensation. Enjoy inserting your own style into the work you do and benefiting from more flexibility at work. This position offers the privilege to impact your earnings and the opportunity to adjust your schedule. Do you have a strong work ethic and high integrity? Then this very rewarding and autonomous role might just be the right fit! COMPENSATION RANGE: $120,000.00 to $200,000.00 annually GENERAL SUMMARY: Provide field-based case management services (within the worker's compensation industry) by utilizing professional judgment and discretion, applying professional processes, and adhering to Case Management Society of America (CMSA), ISYS, and customer guidelines. Facilitate appropriate qualitative and timely medical care for injured workers by implementing prudent case management strategies, demonstrating proactive communication, and appropriate coordination with all parties to enable optimal recovery outcomes, including return to work determination, file progression towards Permanent and Stationary designation, and cost containment for the customer. Facilitate timely claim resolution through proactive and professional communications, conducting case specific research, information analysis and providing appropriate advice, direction, and action plans to implement treatment and optimize realistic outcomes. ESSENTIAL JOB FUNCTIONS: Frequent travel (Driving) throughout designated geographical service areas to in- person appointments/visits. Potential overnight or air travel for special occasions or special geographies, or for coverage purposes. Management of cases as assigned by ISYS, including “rush”/same day referrals from ISYS' customers and attendance at medical appointments scheduled during the hours of the facilities providing treatment. Autonomous management of assigned caseload, including coordination of weekly and daily work activities and schedule, ensuring optimal time management and professional prioritization of all activities. Conducting onsite Case Management services following the CMSA guidelines and ISYS protocols and procedures. Enthusiastically and professionally coordinate, facilitate, conduct, and complete in-person attendance at physician appointments, hospital visits, case conferences, home visits, and ancillary providers to facilitate treatment recommendations in a timely manner. Initiate and conduct professional discussions with medical providers regarding diagnosis, treatment, and prognosis. Apply the case management process, education, and experience to facilitate appropriate and timely treatment and recovery of the injured worker with the goal of maximal recovery and maximal return to work. Provide proactive and timely communication, and coordinate collaboration with all parties involved in each case, in-person, by phone, and/or in writing. Support the injured worker's progress towards achieving Maximum Medical Improvement and foster realistic and effective Return to Work opportunities by exploring viable options with all involved parties. Provide field-based case management services (within the worker's compensation industry) by utilizing professional judgment and discretion, applying professional processes, and adhering to Case Management Society of America (CMSA), ISYS, and customer guidelines. Facilitate appropriate qualitative and timely medical care for injured workers by implementing prudent case management strategies, demonstrating proactive communication, and appropriate coordination with all parties to enable optimal recovery outcomes, including return to work determination, file progression towards Permanent and Stationary designation, and cost containment for the customer. Facilitate timely claim resolution through proactive and professional communications, conducting case specific research, information analysis and providing appropriate advice, direction, and action plans to implement treatment and optimize realistic outcomes. REQUIREMENTS: High School Diploma Current valid State Driver's license Registered Nurse (RN-BC) Outstanding English language skills: speaking, writing, grammar, professional communication Proficient working with PCs and Windows and MS Office Suite (ability to type/key at a moderate speed) and willingness to learn new technologies Excellent prioritization, problem solving, organization and time management Strong character: Dependability, Honesty, Determination and Compassion Ability and willingness to obtain CCM certification after the first year of employment Ability and willingness to establish home office with strong internet connection Understanding and appreciation of excellent customer service and a desire to serve All credentials and licensure must be valid and maintained NOT REQUIRED BUT PREFERRED: Bachelor's Degree or Higher Education Related Certifications: CCM, CDMS, ACM, LCSW and/or CRC Background in Nursing, Social Work, Counseling, Occupational Health, Psychology, and/or Chiropractic. GREAT BENEFITS: The ability to impact your own income through conscious effort is such a rare privilege and is one of the main perks of this special position. Compensation includes both biweekly salary and bonus. Ongoing bonus pay is not capped which means high earning potential is in your hands. The opportunity to adjust your work schedule and navigate your responsibilities in a way that fits your personal preference and workstyle. Rest and relaxation are important, so PTO (vacation) is accrued monthly. Plus, you can earn bonus PTO rewards annually and enjoy even more time off. A benefits package with tax-deferred retirement program, a flexible schedule, medical, dental, and vision insurance, ancillary supplement health plans, Long-term disability insurance, and employee assistance program. ABOUT ISYS CASE MANAGEMENT: ISYS is an organization of people with big minds, big hearts, lots of spirit and good character whose mission is to work creatively and intensively to provide case management solutions and have a positive impact on those we serve. Providing forward focused care coordination and customer service in the workers compensation community since 1998, ISYS has an established brand reputation of delivering on our promise to provide consistent high quality catastrophic, rush, and onsite field medical case management services. Our company culture is based on living our values to: Always do the right thing Deliver excellence in everything we do Encourage a Hug Your Customer philosophy Communicate respectfully and proactively Build relationships upon trust Give generously Pursue growth and learning Be honest, authentic, grateful, and humble Promote individual and economic liberty Embrace the family spirit Annual employee surveys are conducted as part of holding ourselves accountable to living these values and delivering on our promise to our employees. Annual team building, annual gatherings to acknowledge exceptional performance, and routine hugging are all part of our work family culture. ISYS also has a Charitable Activities Committee that oversees and promotes employee involvement in our Pay it Forward program, which focuses on different ways to give back to the communities in which we live and work. Thank you for your interest in working with ISYS! Find employee testimonials and check us out at ************** For more information about our Privacy Practices please see our company website privacy policy at *******************************************************************************

To initiate and coordinate a multidisciplinary team approach to case management. Engages the member/member's representative in a care plan that assists the member in meeting his/her health and wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet the comprehensive medical, behavioral, and psychosocial needs of the member, while promoting quality and cost-effective outcomes. Responsibilities Provides case management services independently for a caseload ranging in complexity from basic to complex; acuity levels 1-4; performs field-based case management (acuity level 5) with supervision. Initiates and coordinates individualized care plan for assigned members, addressing both clinical and non-clinical components, and ensuring the care plan is available to both the member and primary care provider. Resolves member needs by utilizing multidisciplinary team strategies, including Health Services Integrated Rounds Meetings. Ensures a smooth implementation and continuum of care via effective and frequent communication with providers, members, and identified health care designee. Communicates clearly and effectively through all mediums of communication with members, providers, vendors, community partners, and Partnership employees. Coordinates referrals and authorizations for services required to improve the member's health status. Maintains accurate and timely documentation, records, and case files in the Partnership Case Management System for members in case management. Applies evidence-based interventions based upon member's agreed upon goals/priorities Develops and maintains knowledge of a community based network of alternative modes of care; aids member to connect with community-based organizations to support and enhance wellness. Answers and triages department calls, and distributes department referrals with guidance, in accordance with identified department service levels. Collaborates and coordinates with other internal departments to identify members suitable for case management. Actively participates in essential skills training, unit and departmental assigned learning, and other departmental activities as assigned. Functions collaboratively in a team environment, including acting as a support and resource to other staff. Coordinates and participates in meetings with Partnership providers, as assigned. Collaborates with other departments with coordination of care needs through the course of case management services. Demonstrates competence in NCQA documentation standards. Exhibits high professional standards as outlined in the CA Nurse Practice Act and Partnership's Code of Conduct. Performs other duties as assigned by the direct supervisor, including the assumption of new duties. Qualifications Education and Experience Associate's degree in Nursing required; Bachelor's degree in Nursing (or higher) preferred. 2 years of experience preferred, to include at least one (1) year of case management experience and one (1) year in an acute care setting; or equivalent combination of education and experience. General knowledge of managed care and/or experience with Medicaid population preferred. Special Skills, Licenses and Certifications Current and unrestricted California Registered Nurse License. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business. Bilingual skills in Spanish, Russian, or Tagalog preferred. Performance Based Competencies Strong organizational, communication, critical thinking skills and attention to detail required. Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines. Effective telephone and computer data entry skills required. Experience in managed care business practices and ability to access data information using various computer systems. Excellent English written and verbal communication skills required. Work Environment And Physical Demands Able to utilize multiple computer platforms simultaneously. Daily use of telephone and computer for most of the day. Standard cubicle workstation. Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan's policies and procedures, as they may from time to time be updated. HIRING RANGE: $49.54 - $64.41 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change

FLSA Status: Exempt Department: Health Services Reports To: Health Services Management Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521 The RN Case Manager is responsible for providing on-going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate, the RN Case Manager facilitates communication and coordination among all participants of the care team to ensure member identified goals and needed services are provided to promote quality cost-effective outcomes. Through the development and implementation of member individualized care plans, the RN Case Manager provides medical and psychosocial case management support to help coordinate resources and services for individuals across the healthcare and social services continuum, and facilitate the use of available healthcare benefits in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. * Conduct, review and document comprehensive clinical and/or psychosocial assessments and on-going follow-up interventions to measure progress towards meeting goals as they relate to a member's physical, psychosocial, environmental, safety, developmental, cultural and linguistic needs. * Maintain case files by assuring that they are documented in accordance with SCFHP policies and procedures, state and federal requirements and organized in a manner that adheres to standards for audit requirements. * Facilitate involvement of the member and/or family/responsible party for development and implementation of a member specific care plan which includes individualized prioritized goals. * Coordinate member's care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community. * Facilitate and coordinate communication with member's interdisciplinary care team including SCFHP internal staff, as well as the member's physicians, specialists, public services, community agencies and vendors to ensure care plan development and coordination of benefits and services. * Facilitate successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance and by facilitating utilization review. * If assigned to MLTSS, support the transition of long-term care members residing in nursing facilities to a lower level of care, or community setting in partnership with MLTSS providers and programs. * If assigned to Community Based Adult Services (CBAS): * Conduct face-to-face, on-site eligibility determinations for CBAS services with members using the standardized California Department of Health Services approved tool - CBAS Eligibility Determination Tool (CEDT) & Patient Health Record Quick Guide; * Review and approve Individual Plan of Care for CBAS members; and * Provide care coordination to targeted CBAS members including assessment, care plan implementation and care transitions. * Conduct telephonic and/or visits/assessments, as needed in the home, facility or community setting. * Collaborate with team members on cross-departmental improvement efforts, quality improvement projects, optimization of utilization management, and improvement of member satisfaction. * Attend and actively participate in Health Services meetings, operational meetings, training and coaching sessions, including off-site meetings as needed. * Perform other duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Active California RN License without restriction. (R) * Minimum three years of experience in case management, discharge planning, or education or certifications, or equivalent experience. (R) * Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management. (R) * Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care needs necessary to develop an effective care plan. (R) * Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) * Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D) * Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children). (D) * Ability to work within an interdisciplinary team structure. (R) * Ability to conduct home, facility and other community-based visits. (R) * Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) * Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R) * Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R ) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing as mandated by nursing scope of practice. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely and with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels.

FLSA Status: Exempt Department: Health Services Reports To: Health Services Management The RN Case Manager is responsible for providing on-going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate, the RN Case Manager facilitates communication and coordination among all participants of the care team to ensure member identified goals and needed services are provided to promote quality cost-effective outcomes. Through the development and implementation of member individualized care plans, the RN Case Manager provides medical and psychosocial case management support to help coordinate resources and services for individuals across the healthcare and social services continuum, and facilitate the use of available healthcare benefits in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. * Conduct, review and document comprehensive clinical and/or psychosocial assessments and on-going follow-up interventions to measure progress towards meeting goals as they relate to a member's physical, psychosocial, environmental, safety, developmental, cultural and linguistic needs. * Maintain case files by assuring that they are documented in accordance with SCFHP policies and procedures, state and federal requirements and organized in a manner that adheres to standards for audit requirements. * Facilitate involvement of the member and/or family/responsible party for development and implementation of a member specific care plan which includes individualized prioritized goals. * Coordinate member's care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community. * Facilitate and coordinate communication with member's interdisciplinary care team including SCFHP internal staff, as well as the member's physicians, specialists, public services, community agencies and vendors to ensure care plan development and coordination of benefits and services. * Facilitate successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance and by facilitating utilization review. * If assigned to MLTSS, support the transition of long-term care members residing in nursing facilities to a lower level of care, or community setting in partnership with MLTSS providers and programs. * If assigned to Community Based Adult Services (CBAS): * Conduct face-to-face, on-site eligibility determinations for CBAS services with members using the standardized California Department of Health Services approved tool - CBAS Eligibility Determination Tool (CEDT) & Patient Health Record Quick Guide; * Review and approve Individual Plan of Care for CBAS members; and * Provide care coordination to targeted CBAS members including assessment, care plan implementation and care transitions. * Conduct telephonic and/or visits/assessments, as needed in the home, facility or community setting. * Collaborate with team members on cross-departmental improvement efforts, quality improvement projects, optimization of utilization management, and improvement of member satisfaction. * Attend and actively participate in Health Services meetings, operational meetings, training and coaching sessions, including off-site meetings as needed. * Perform other duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Active California RN License without restriction. (R) * Minimum three years of experience in case management, discharge planning, or education or certifications, or equivalent experience. (R) * Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management. (R) * Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care needs necessary to develop an effective care plan. (R) * Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) * Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D) * Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children). (D) * Ability to work within an interdisciplinary team structure. (R) * Ability to conduct home, facility and other community-based visits. (R) * Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) * Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R) * Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R ) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing as mandated by nursing scope of practice. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely and with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels.

To initiate and coordinate a multidisciplinary team approach to case management. Engages the member/member's representative in a care plan that assists the member in meeting his/her health and wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet the comprehensive medical, behavioral, and psychosocial needs of the member, while promoting quality and cost-effective outcomes. Responsibilities Provides case management services independently for a caseload ranging in complexity from basic to complex; acuity levels 1-4; performs field-based case management (acuity level 5) with supervision. Initiates and coordinates individualized care plan for assigned members, addressing both clinical and non-clinical components, and ensuring the care plan is available to both the member and primary care provider. Resolves member needs by utilizing multidisciplinary team strategies, including Health Services Integrated Rounds Meetings. Ensures a smooth implementation and continuum of care via effective and frequent communication with providers, members, and identified health care designee. Communicates clearly and effectively through all mediums of communication with members, providers, vendors, community partners, and Partnership employees. Coordinates referrals and authorizations for services required to improve the member's health status. Maintains accurate and timely documentation, records, and case files in the Partnership Case Management System for members in case management. Applies evidence-based interventions based upon member's agreed upon goals/priorities Develops and maintains knowledge of a community based network of alternative modes of care; aids member to connect with community-based organizations to support and enhance wellness. Answers and triages department calls, and distributes department referrals with guidance, in accordance with identified department service levels. Collaborates and coordinates with other internal departments to identify members suitable for case management. Actively participates in essential skills training, unit and departmental assigned learning, and other departmental activities as assigned. Functions collaboratively in a team environment, including acting as a support and resource to other staff. Coordinates and participates in meetings with Partnership providers, as assigned. Collaborates with other departments with coordination of care needs through the course of case management services. Demonstrates competence in NCQA documentation standards. Exhibits high professional standards as outlined in the CA Nurse Practice Act and Partnership's Code of Conduct. Performs other duties as assigned by the direct supervisor, including the assumption of new duties. Qualifications Education and Experience Associate's degree in Nursing required; Bachelor's degree in Nursing (or higher) preferred. 2 years of experience preferred, to include at least one (1) year of case management experience and one (1) year in an acute care setting; or equivalent combination of education and experience. General knowledge of managed care and/or experience with Medicaid population preferred. Special Skills, Licenses and Certifications Current and unrestricted California Registered Nurse License. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business. Bilingual skills in Spanish, Russian, or Tagalog preferred. Performance Based Competencies Strong organizational, communication, critical thinking skills and attention to detail required. Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines. Effective telephone and computer data entry skills required. Experience in managed care business practices and ability to access data information using various computer systems. Excellent English written and verbal communication skills required. Work Environment And Physical Demands Able to utilize multiple computer platforms simultaneously. Daily use of telephone and computer for most of the day. Standard cubicle workstation. Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan's policies and procedures, as they may from time to time be updated. HIRING RANGE: $49.54 - $64.41 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change

To initiate and coordinate a multidisciplinary team approach to case management. Engages the member/member's representative in a care plan that assists the member in meeting his/her health and wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet the comprehensive medical, behavioral, and psychosocial needs of the member, while promoting quality and cost-effective outcomes. Responsibilities Provides case management services independently for a caseload ranging in complexity from basic to complex; acuity levels 1-4; performs field-based case management (acuity level 5) with supervision. Initiates and coordinates individualized care plan for assigned members, addressing both clinical and non-clinical components, and ensuring the care plan is available to both the member and primary care provider. Resolves member needs by utilizing multidisciplinary team strategies, including Health Services Integrated Rounds Meetings. Ensures a smooth implementation and continuum of care via effective and frequent communication with providers, members, and identified health care designee. Communicates clearly and effectively through all mediums of communication with members, providers, vendors, community partners, and Partnership employees. Coordinates referrals and authorizations for services required to improve the member's health status. Maintains accurate and timely documentation, records, and case files in the Partnership Case Management System for members in case management. Applies evidence-based interventions based upon member's agreed upon goals/priorities Develops and maintains knowledge of a community based network of alternative modes of care; aids member to connect with community-based organizations to support and enhance wellness. Answers and triages department calls, and distributes department referrals with guidance, in accordance with identified department service levels. Collaborates and coordinates with other internal departments to identify members suitable for case management. Actively participates in essential skills training, unit and departmental assigned learning, and other departmental activities as assigned. Functions collaboratively in a team environment, including acting as a support and resource to other staff. Coordinates and participates in meetings with Partnership providers, as assigned. Collaborates with other departments with coordination of care needs through the course of case management services. Demonstrates competence in NCQA documentation standards. Exhibits high professional standards as outlined in the CA Nurse Practice Act and Partnership's Code of Conduct. Performs other duties as assigned by the direct supervisor, including the assumption of new duties. Qualifications Education and Experience Associate's degree in Nursing required; Bachelor's degree in Nursing (or higher) preferred. 2 years of experience preferred, to include at least one (1) year of case management experience and one (1) year in an acute care setting; or equivalent combination of education and experience. General knowledge of managed care and/or experience with Medicaid population preferred. Special Skills, Licenses and Certifications Current and unrestricted California Registered Nurse License. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business. Bilingual skills in Spanish, Russian, or Tagalog preferred. Performance Based Competencies Strong organizational, communication, critical thinking skills and attention to detail required. Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines. Effective telephone and computer data entry skills required. Experience in managed care business practices and ability to access data information using various computer systems. Excellent English written and verbal communication skills required. Work Environment And Physical Demands Able to utilize multiple computer platforms simultaneously. Daily use of telephone and computer for most of the day. Standard cubicle workstation. Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan's policies and procedures, as they may from time to time be updated. HIRING RANGE: $49.54 - $64.41 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change

To initiate and coordinate a multidisciplinary team approach to case management. Engages the member/member's representative in a care plan that assists the member in meeting his/her health and wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet the comprehensive medical, behavioral, and psychosocial needs of the member, while promoting quality and cost-effective outcomes. Responsibilities Provides case management services independently for a caseload ranging in complexity from basic to complex; acuity levels 1-4; performs field-based case management (acuity level 5) with supervision. Initiates and coordinates individualized care plan for assigned members, addressing both clinical and non-clinical components, and ensuring the care plan is available to both the member and primary care provider. Resolves member needs by utilizing multidisciplinary team strategies, including Health Services Integrated Rounds Meetings. Ensures a smooth implementation and continuum of care via effective and frequent communication with providers, members, and identified health care designee. Communicates clearly and effectively through all mediums of communication with members, providers, vendors, community partners, and PHC employees. Coordinates referrals and authorizations for services required to improve the member's health status. Maintains accurate and timely documentation, records, and case files in the PHC Case Management System for members in case management. Applies evidence-based interventions based upon member's agreed upon goals/priorities Develops and maintains knowledge of a community based network of alternative modes of care; aids member to connect with community-based organizations to support and enhance wellness. Answers and triages department calls, and distributes department referrals with guidance, in accordance with identified department service levels. Collaborates and coordinates with other internal departments to identify members suitable for case management. Actively participates in essential skills training, unit and departmental assigned learning, and other departmental activities as assigned. Functions collaboratively in a team environment, including acting as a support and resource to other staff. Coordinates and participates in meetings with PHC providers, as assigned. Collaborates with other departments with coordination of care needs through the course of case management services. Demonstrates competence in NCQA documentation standards. Exhibits high professional standards as outlined in the CA Nurse Practice Act and PHC's Code of Conduct. Performs other duties as assigned by the direct supervisor, including the assumption of new duties. Qualifications Education and Experience Associate's degree in Nursing required; Bachelor's degree in Nursing (or higher) preferred. 2 years of experience preferred, to include at least one (1) year of case management experience and one (1) year in an acute care setting; or equivalent combination of education and experience. General knowledge of managed care and/or experience with Medicaid population preferred. Special Skills, Licenses and Certifications Current and unrestricted California Registered Nurse License. Valid California driver's license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business. Bilingual skills in Spanish, Russian, or Tagalog preferred. Performance Based Competencies Strong organizational, communication, critical thinking skills and attention to detail required. Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines. Effective telephone and computer data entry skills required. Experience in managed care business practices and ability to access data information using various computer systems. Excellent English written and verbal communication skills required. Work Environment And Physical Demands Able to utilize multiple computer platforms simultaneously. Daily use of telephone and computer for most of the day. Standard cubicle workstation. Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan's policies and procedures, as they may from time to time be updated. HIRING RANGE: $49.54 - $64.41 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. : Hospice Registered Nurse Case Manager Full Time/Field Based At Elara Caring, we believe the best care happens where people feel most comfortable - at home. Our mission is simple: to bring exceptional care, comfort, and compassion to every patient, every day. But our greatest impact comes from the people who make that care possible - our nurses. As a Registered Nurse Case Manager, you'll do more than deliver outstanding care to patients and families. You'll shape the future of nursing by guiding, training, and empowering new nurses as they begin their journey in hospice and home health. Your leadership and mentorship will ensure that every patient receives care rooted in empathy, skill, and respect. Why You'll Love Being Part of Elara Caring Lead with purpose. Use your clinical expertise to teach, mentor, and inspire new nurses as they grow in confidence and competence. Collaborative culture. Join a team that values communication, connection, and compassion - not just with patients, but with each other. Professional growth. Enjoy tuition reimbursement for full-time staff and free continuing education opportunities for all employees. Competitive benefits. Comprehensive medical, dental, and vision coverage, paid time off, paid holidays, and 401(k) with company match. Support for what matters most. Family and pet bereavement leave, pet insurance, and flexible scheduling to help you balance work and life. What You'll Do Provide comprehensive, compassionate care to patients and their families in their home or facility setting. Assess and coordinate individualized plans of care that address physical, emotional, and spiritual needs. Mentor and train new nurses and team members, ensuring consistent, high-quality care across all cases. Teach hospice philosophy, pain and symptom management, and best practices in communication and patient advocacy. Collaborate closely with physicians, social workers, and other interdisciplinary team members to support holistic patient care. Offer emotional support to families and perform bereavement assessments following patient loss. What You'll Need Graduate of an accredited nursing program (Associate, Diploma, or Bachelor's). Current Registered Nurse (RN) license in the state of practice. Minimum of one year of clinical experience Hospice is required/strongly preferred Strong communication skills and a passion for teaching and mentorship. Valid driver's license, auto insurance, and reliable transportation. Ability to lift, stand, and move intermittently; capable of lifting up to 100 lbs. At Elara Caring, you won't just be part of a team - you'll be part of a movement to nurture, teach, and care with heart. As a growing organization, we invite you to share your information with us for consideration for future career opportunities. This is an exciting chance to connect with our compassionate and dedicated team, who truly value your unique skills and experiences in delivering exceptional care to those we serve. If you're ready to make an impact that reaches beyond your patients and into the next generation of nursing professionals, apply today. We value the unique skills of veterans and military spouses. We encourage applications from military veterans and their families. Elara Caring provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age (40 and older), national origin, religion, disability, genetic information, marital status, sexual orientation, gender identity, gender reassignment, protected veteran status, or any other basis prohibited under applicable federal, state or local law. Elara Caring participates in E-Verify and we will provide the Federal Government with your Form I-9 information to confirm that you are authorized to work in the United States. Employers like Elara Caring can only use E-Verify once you have accepted the job offer and completed the Form I-9. At Elara Caring, pay and compensation are determined by a variety of factors, including education, job-related knowledge, skills, training, and experience. Our compensation structure reflects the cost of labor across different U.S. geographic markets, and may vary based on location. This is not a comprehensive list of all job responsibilities and requirements; upon request, a job description can be provided. If you are an individual with a disability and are unable or limited in your ability to use or access our career site as a result of your disability, you may request reasonable accommodations by reaching out to ********************.

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. : Registered Nurse Case Manager Salaried (JP506E) At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there's no place like home, and that's why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their journey of health, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Registered Nurse Case Manager. Being a part of something this great starts by carrying out our mission every day through your true calling: developing an amazing team of compassionate and dedicated healthcare providers. To continue to be an industry pioneer in delivering unparalleled care, we need a Registered Nurse Case Manager with commitment and compassion. Are you one of them? If so, apply today! Why Join the Elara Caring mission? Work in a collaborative environment. Be rewarded with a unique opportunity to make a difference Competitive compensation package Tuition reimbursement for full-time staff and continuing education opportunities for all employees at no cost Opportunities for advancement Comprehensive insurance plans for medical, dental, and vision benefits 401(K) with employer match Paid time off, paid holidays, family, and pet bereavement Pet insurance As a Registered Nurse Case Manager, you'll contribute to our success in the following ways: Ensures that all activities performed align with the vision of Elara Caring's board of directors, executive team, and the leadership of the Hospice team. Assesses hospice care patients and families to identify the physical, psychosocial, and environmental needs of patients as evidenced by documentation, clinical records, Interdisciplinary Team reports, after hours reports, and on-site evaluations. Assesses patient needs and obtains data on physical, psychological, social, and spiritual factors that may influence patient/family/caregiver health status. Communicates significant findings, problems, and changes in health condition, environment, or unsafe facility conditions to the Clinical Supervisor, physician, facility, and/or other personnel involved with patient care. Counsels, instructs, and includes the patient, facility, and family in following the Interdisciplinary Plan of Care. Teaches hospice philosophy and pain and symptom management to staff in alternate care settings (nursing homes, hospital, assisted-living facilities, etc.). Provides appropriate support at time of death and perform bereavement assessment. What is Required? Graduate of an accredited Certificate, Diploma, Associate, or Baccalaureate School of Nursing Current State License as a Registered Nurse RN 1 year of experience in a clinical care setting Experience in a hospice or home health environment is preferred 50% travel required Sit, stand, bend, lift and move intermittently and be able to lift 50-100 lbs. Valid driver's license and insurance and reliable transportation to perform job tasks You will report to the Clinical Team Manager. We value the unique skills of veterans and military spouses. We encourage applications from military veterans and their families. Elara Caring provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age (40 and older), national origin, religion, disability, genetic information, marital status, sexual orientation, gender identity, gender reassignment, protected veteran status, or any other basis prohibited under applicable federal, state or local law. Elara Caring participates in E-Verify and we will provide the Federal Government with your Form I-9 information to confirm that you are authorized to work in the United States. Employers like Elara Caring can only use E-Verify once you have accepted the job offer and completed the Form I-9. At Elara Caring, pay and compensation are determined by a variety of factors, including education, job-related knowledge, skills, training, and experience. Our compensation structure reflects the cost of labor across different U.S. geographic markets, and may vary based on location. This is not a comprehensive list of all job responsibilities and requirements; upon request, a job description can be provided. If you are an individual with a disability and are unable or limited in your ability to use or access our career site as a result of your disability, you may request reasonable accommodations by reaching out to ********************.

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. : TERRITORY- MORGAN, HENDRICKS, MARION At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there's no place like home, and that's why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their journey of health, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Registered Nurse Case Manager. Being a part of something this great starts by carrying out our mission every day through your true calling: developing an amazing team of compassionate and dedicated healthcare providers. To continue to be an industry pioneer in delivering unparalleled care, we need a Registered Nurse Case Manager with commitment and compassion. Are you one of them? If so, apply today! Why Join the Elara Caring mission? Work in a collaborative environment. Be rewarded with a unique opportunity to make a difference Competitive compensation package Tuition reimbursement for full-time staff and continuing education opportunities for all employees at no cost Opportunities for advancement Comprehensive insurance plans for medical, dental, and vision benefits 401(K) with employer match Paid time off, paid holidays, family, and pet bereavement Pet insurance As a Registered Nurse Case Manager, you'll contribute to our success in the following ways: Ensures that all activities performed align with the vision of Elara Caring's board of directors, executive team, and the leadership of the Hospice team. Assesses hospice care patients and families to identify the physical, psychosocial, and environmental needs of patients as evidenced by documentation, clinical records, Interdisciplinary Team reports, after hours reports, and on-site evaluations. Assesses patient needs and obtains data on physical, psychological, social, and spiritual factors that may influence patient/family/caregiver health status. Communicates significant findings, problems, and changes in health condition, environment, or unsafe facility conditions to the Clinical Supervisor, physician, facility, and/or other personnel involved with patient care. Counsels, instructs, and includes the patient, facility, and family in following the Interdisciplinary Plan of Care. Teaches hospice philosophy and pain and symptom management to staff in alternate care settings (nursing homes, hospital, assisted-living facilities, etc.). Provides appropriate support at time of death and perform bereavement assessment. What is Required? Graduate of an accredited Certificate, Diploma, Associate, or Baccalaureate School of Nursing Current State License as a Registered Nurse RN 1 year of experience in a clinical care setting Experience in a hospice or home health environment is preferred 50% travel required Sit, stand, bend, lift and move intermittently and be able to lift 50-100 lbs. Valid driver's license and insurance and reliable transportation to perform job tasks You will report to the Clinical Team Manager. We value the unique skills of veterans and military spouses. We encourage applications from military veterans and their families. Elara Caring provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age (40 and older), national origin, religion, disability, genetic information, marital status, sexual orientation, gender identity, gender reassignment, protected veteran status, or any other basis prohibited under applicable federal, state or local law. Elara Caring participates in E-Verify and we will provide the Federal Government with your Form I-9 information to confirm that you are authorized to work in the United States. Employers like Elara Caring can only use E-Verify once you have accepted the job offer and completed the Form I-9. At Elara Caring, pay and compensation are determined by a variety of factors, including education, job-related knowledge, skills, training, and experience. Our compensation structure reflects the cost of labor across different U.S. geographic markets, and may vary based on location. This is not a comprehensive list of all job responsibilities and requirements; upon request, a job description can be provided. If you are an individual with a disability and are unable or limited in your ability to use or access our career site as a result of your disability, you may request reasonable accommodations by reaching out to ********************.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. Nurse Case Manager in a specialty area including but not limited to disability and psychiatry case management. Makes assessments and determinations applying various case and disability management principles within area of specialty. Ensures expeditious and effective claims decisions through collaboration with healthcare providers, employers, claimants and claims staff. JOB DESCRIPTION: Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: * Assesses disability status, makes recommendations and identifies appropriate resources. * Accountable for gathering and coordinating medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and assigns length of disability. * Consults on case management issues in area of specialty and applies effective case management interventions. * Collaborates with medical and other providers to ensure appropriate treatment and return to work. * Facilitates job modifications when appropriate and educates involved parties regarding claims process and functionality as it relates to job requirements while remaining externally focused. * Addresses causality and refers to appropriate medical expertise. * Documents according to jurisdictional, departmental and accreditation requirements. Reporting Relationship Typically Lead Specialty Nurse Case Manager Skills, Knowledge and Abilities * Strong knowledge of case management, specialty area, medical terminology and conditions, insurance industry as well as company policies and procedures. * Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service. * Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner. * Strong interpersonal skills with the ability to effectively interact with internal and external business partners. * Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks. * Knowledge of Microsoft Office Suite as well as other business related software. * Ability to work independently. Education and Experience * RN with BSN preferred. Eligible to sit for national case management certifications. * Typically a minimum five years diverse clinical background, with two or more years disability management experience preferred #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. Nurse Case Manager in a specialty area including but not limited to disability and psychiatry case management. Makes assessments and determinations applying various case and disability management principles within area of specialty. Ensures expeditious and effective claims decisions through collaboration with healthcare providers, employers, claimants and claims staff. JOB DESCRIPTION: Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: Assesses disability status, makes recommendations and identifies appropriate resources. Accountable for gathering and coordinating medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and assigns length of disability. Consults on case management issues in area of specialty and applies effective case management interventions. Collaborates with medical and other providers to ensure appropriate treatment and return to work. Facilitates job modifications when appropriate and educates involved parties regarding claims process and functionality as it relates to job requirements while remaining externally focused. Addresses causality and refers to appropriate medical expertise. Documents according to jurisdictional, departmental and accreditation requirements. Reporting Relationship Typically Lead Specialty Nurse Case Manager Skills, Knowledge and Abilities Strong knowledge of case management, specialty area, medical terminology and conditions, insurance industry as well as company policies and procedures. Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service. Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner. Strong interpersonal skills with the ability to effectively interact with internal and external business partners. Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks. Knowledge of Microsoft Office Suite as well as other business related software. Ability to work independently. Education and Experience RN with BSN preferred. Eligible to sit for national case management certifications. Typically a minimum five years diverse clinical background, with two or more years disability management experience preferred #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois , Maryland, Massachusetts , New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. : At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there's no place like home, and that's why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their journey of health, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Registered Nurse. Being a part of something this great starts by carrying out our mission every day through your true calling: developing an amazing team of compassionate and dedicated healthcare providers. To continue to be an industry pioneer in delivering unparalleled care, we need a Registered Nurse with commitment and compassion. Are you one of them? If so, apply today! Why Join the Elara Caring mission? Work in a collaborative environment. Be rewarded with a unique opportunity to make a difference Competitive compensation package Tuition reimbursement for full-time staff and continuing education opportunities for all employees at no cost Opportunities for advancement Comprehensive insurance plans for medical, dental, and vision benefits 401(K) with employer match Paid time off, paid holidays, family, and pet bereavement As a Registered Nurse, you'll contribute to our success in the following ways: Assesses patient needs and obtains data on physical, psychological, social, and spiritual factors that may influence patient/family/caregiver health status and incorporate that data into the plan of care. Conducts the initial evaluation and re-evaluates the patient's nursing needs during each visit. Makes follow up visits according to patient, family, and facility needs. Communicates significant findings, problems, and changes in health condition, environment, or unsafe facility conditions to the Clinical Supervisor, physician, facility, and/or other personnel involved with patient care. Revises the plan of care in response to identified patient care issues and notifies the Clinical Supervisor, physician, facility, and other team members. Counsels, instructs, and includes the patient, facility, and family in following the Interdisciplinary Plan of Care. Teaches hospice philosophy and pain and symptom management to staff in alternate care settings (nursing homes, hospital, assisted-living facilities, etc.). Collaborates/Communicates with Medical Director, attending physician, branch leadership and IDG. Performs other duties/projects as assigned. What is Required? Graduate of an accredited Certificate, Diploma, Associate, or Baccalaureate School of Nursing Current State Licensee as a Registered Nurse RN 1 year of experience in a clinical care setting Experience in hospice or home health environment is preferred Nursing skills as defined by accepted nursing standards Ability to handle multiple priorities, documentation requirements, and deadlines Able and willing to travel up to 50% as needed to support business and patient needs. Sit, stand, bend, lift and move intermittently and be able to lift 50-100 lbs. Valid driver's license and insurance and reliable transportation to perform job tasks You will report to the Clinical Team Manager. We value the unique skills of veterans and military spouses. We encourage applications from military veterans and their families. Elara Caring provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age (40 and older), national origin, religion, disability, genetic information, marital status, sexual orientation, gender identity, gender reassignment, protected veteran status, or any other basis prohibited under applicable federal, state or local law. Elara Caring participates in E-Verify and we will provide the Federal Government with your Form I-9 information to confirm that you are authorized to work in the United States. Employers like Elara Caring can only use E-Verify once you have accepted the job offer and completed the Form I-9. At Elara Caring, pay and compensation are determined by a variety of factors, including education, job-related knowledge, skills, training, and experience. Our compensation structure reflects the cost of labor across different U.S. geographic markets, and may vary based on location. This is not a comprehensive list of all job responsibilities and requirements; upon request, a job description can be provided. If you are an individual with a disability and are unable or limited in your ability to use or access our career site as a result of your disability, you may request reasonable accommodations by reaching out to ********************.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. Nurse Case Manager in a specialty area including but not limited to disability and psychiatry case management. Makes assessments and determinations applying various case and disability management principles within area of specialty. Ensures expeditious and effective claims decisions through collaboration with healthcare providers, employers, claimants and claims staff. JOB DESCRIPTION: Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: * Assesses disability status, makes recommendations and identifies appropriate resources. * Accountable for gathering and coordinating medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and assigns length of disability. * Consults on case management issues in area of specialty and applies effective case management interventions. * Collaborates with medical and other providers to ensure appropriate treatment and return to work. * Facilitates job modifications when appropriate and educates involved parties regarding claims process and functionality as it relates to job requirements while remaining externally focused. * Addresses causality and refers to appropriate medical expertise. * Documents according to jurisdictional, departmental and accreditation requirements. Reporting Relationship Typically Lead Specialty Nurse Case Manager Skills, Knowledge and Abilities * Strong knowledge of case management, specialty area, medical terminology and conditions, insurance industry as well as company policies and procedures. * Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service. * Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner. * Strong interpersonal skills with the ability to effectively interact with internal and external business partners. * Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks. * Knowledge of Microsoft Office Suite as well as other business related software. * Ability to work independently. Education and Experience * RN with BSN preferred. Eligible to sit for national case management certifications. * Typically a minimum five years diverse clinical background, with two or more years disability management experience preferred #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

FUNCTION OF THE JOB: The Workers Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate, cost-effective medical treatment of injured employees with the goal of optimum medical improvement. The TCM is responsible for disability management, including proactive early return to work coordination. Close collaboration with the claims and medical team to achieve individual case and department goals is a critical component of the position. This is a full-time remote position KNOWLEDGE AND SKILLS: Excellent verbal and written communication skills. This position will involve continuous personal, telephonic, and written contact. Strong interpersonal and relationship building skills. Knowledge of traumatic injuries and the resultant disabilities and medical complications. Knowledge of Worker's Compensation Acts and working knowledge of the medical providers in the assigned territory. Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines. Experience using Microsoft Office products and ability to learn other technology tools. Strong time management, critical thinking, and organizational skills with the ability to work independently to manage priorities and meet deadlines MAJOR DUTIES/RESPONSIBILITIES OF THE JOB: Complete timely initial assessment report, case management plan, and establish disability duration timeframes. Throughout the life of an assignment review, analyze and critically assess medical records compared to evidence-based treatment guidelines; communicate findings and recommendations to the adjuster as part of the development of a medical action plan. Active participation with claims team to review, establish, and execute action plan. Develop and maintain action plan for early return to work (RTW) based on disability duration guidelines. Work collaboratively with all stakeholders to effectively manage recovery and return to work process. Meet productivity requirements. Effectively manage inventory based on guidelines. EDUCATION AND EXPERIENCE: Registered Nurse (RN) license in good standing required and willingness to obtain additional licenses as needed. BSN preferred. Certified Case Manager (CCM) certification, CDMS and/or CRRN preferred. Compact license preferred. 3-year experience in Workers Compensation Case Management preferred. Proficiency with MS Office products Bi-lingual in Spanish a plus The pay range for the role is $65,900 to $111,900. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.

FUNCTION OF THE JOB: The Workers Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate, cost-effective medical treatment of injured employees with the goal of optimum medical improvement. The TCM is responsible for disability management, including proactive early return to work coordination. Close collaboration with the claims and medical team to achieve individual case and department goals is a critical component of the position. This is a full-time remote position KNOWLEDGE AND SKILLS: * Excellent verbal and written communication skills. This position will involve continuous personal, telephonic, and written contact. * Strong interpersonal and relationship building skills. * Knowledge of traumatic injuries and the resultant disabilities and medical complications. * Knowledge of Worker's Compensation Acts and working knowledge of the medical providers in the assigned territory. * Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines. * Experience using Microsoft Office products and ability to learn other technology tools. * Strong time management, critical thinking, and organizational skills with the ability to work independently to manage priorities and meet deadlines MAJOR DUTIES/RESPONSIBILITIES OF THE JOB: * Complete timely initial assessment report, case management plan, and establish disability duration timeframes. * Throughout the life of an assignment review, analyze and critically assess medical records compared to evidence-based treatment guidelines; communicate findings and recommendations to the adjuster as part of the development of a medical action plan. * Active participation with claims team to review, establish, and execute action plan. * Develop and maintain action plan for early return to work (RTW) based on disability duration guidelines. * Work collaboratively with all stakeholders to effectively manage recovery and return to work process. * Meet productivity requirements. * Effectively manage inventory based on guidelines. EDUCATION AND EXPERIENCE: * Registered Nurse (RN) license in good standing required and willingness to obtain additional licenses as needed. BSN preferred. * Certified Case Manager (CCM) certification, CDMS and/or CRRN preferred. * Compact license preferred. * 3-year experience in Workers Compensation Case Management preferred. * Proficiency with MS Office products * Bi-lingual in Spanish a plus The pay range for the role is $65,900 to $111,900. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.

About Lucent Health Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers. Company Culture We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health. Honest Transparent Communication: be open and clear in all interactions without withholding crucial information Integrity: ensure accuracy in reporting, work outputs and any tasks assigned Truthfulness: provide honest feedback and report any issues or challenges as they arise Trustworthiness: build and maintain trust by consistently demonstrating reliable behavior Ethical Fair Decision Making: ensure all actions and decisions respect company policies and values Accountability: own up to mistakes and take responsibility for rectifying them Respect: treat colleagues, clients and partners with fairness and dignity Confidentiality: safeguard sensitive information and avoid conflicts of interest Hardworking Consistency: meet or exceed deadlines, maintaining high productivity levels Proactiveness: take initiative to tackle challenges without waiting to be asked Willingness: voluntarily offer to assist in additional projects or tasks when needed Adaptability: work efficiently under pressure or in changing environments Summary: The Case Manager shall work with the entire team to provide appropriate, comprehensive, and proactive onsite and telephonic case management services and to promote the provision of only the highest quality, most appropriate, cost-effective healthcare to plan participants with chronic or catastrophic illnesses or injuries, in accordance with applicable laws, the CCM/CMSA Standards of Practice, the company policies and procedures according to the AAHC/URAC Guidelines. Responsibilities: The Case Manager, under the direction and supervision of a Certified Case Management (CCM) Professional and acting in a Patient Advocate capacity and according to AAHC/URAC standards, The Case Manager shall perform all phases of the case management process, which shall include: Defines role and scope of activities to the patient in a comprehensible manner. Communicates to the patient that the information gathered will be shared with the payer. Gathers consent for case management activities. Determines individual needs based on an assessment that identifies all significant needs related to the Medical condition and care Works in a holistic manner, considering both medical and psychosocial issues. Identifies issues that might interfere with the provision of the highest quality, most appropriate, cost-effective care. Creates an individualized plan of action based on the assessment, which facilitates the coordination of appropriate and necessary treatment, and services required by the patient. Gives consideration, in developing the plan, to the benefit plan design/coverage options. Sets appropriate, measurable goals. Provides the patient with information to make "informed" decisions, empowering and encouraging the patient to make his own decisions through including him in the planning process. Develops contingency plans. Facilitates communication of the patient's wishes to all members of the health care team. When appropriate, discuss advanced directives with patient/family. Obtains the acceptance of all parties (patient, family, payer, and providers) prior to instituting the plan. Works within the health plan provisions. Refers to only those providers that are familiar or researched to ensure high quality (either through personal knowledge/experience, onsite inspections, conversations with providers, review of accreditations and credentials, networking with other case managers, review of outcomes, statistics, payer, and patient satisfaction). Evaluates plan on a regular basis to determine effectiveness, patient satisfaction, provider comfort, payer satisfaction, if the plan is meeting the needs of all involved parties (but most particularly-the patient's needs) cost effectiveness, patient compliance with treatment, and the impact on the patient's quality of life. Determines if revisions are required due to changes in medical condition, family status, insurance coverage, etc. Maintains well-organized, objective, factual, clear, and concise documentation that reflects what was done on the cases and why it was done, adhering to policies regarding timeliness. Performs as a patient advocate, in an ethical manner always, incorporating case management concepts and following industry standards and guidelines. Becomes involved in the case management process as early as possible following the onset or diagnosis and maintains involvement throughout the course of the illness or injury Qualifications: Registered Nurse with a minimum of 5 years Clinical Experience Credentials such as CCM/CRRN, OCN or other pertinent certifications (preferred) Excellent written, telephone, and computer skills Positive, proactive, team-oriented approach/attitude Time management and organizational skills, flexible, with the ability to work independently. Active, unrestricted multi-state license Recent clinical experience Equal Employment Opportunity Policy Statement Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.

About Lucent Health Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers. Company Culture We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health. Honest Transparent Communication: be open and clear in all interactions without withholding crucial information Integrity: ensure accuracy in reporting, work outputs and any tasks assigned Truthfulness: provide honest feedback and report any issues or challenges as they arise Trustworthiness: build and maintain trust by consistently demonstrating reliable behavior Ethical Fair Decision Making: ensure all actions and decisions respect company policies and values Accountability: own up to mistakes and take responsibility for rectifying them Respect: treat colleagues, clients and partners with fairness and dignity Confidentiality: safeguard sensitive information and avoid conflicts of interest Hardworking Consistency: meet or exceed deadlines, maintaining high productivity levels Proactiveness: take initiative to tackle challenges without waiting to be asked Willingness: voluntarily offer to assist in additional projects or tasks when needed Adaptability: work efficiently under pressure or in changing environments Summary The maternity case manager shall work in a collaborative means to promote quality care and cost- effective outcomes that will enhance the physical, psychosocial, and vocational health of the plan participants. The case manager shall work within the policies and procedures of Lucent Health and according to the Practice Guidelines accepted by the profession of case management. Responsibilities Performs all phases of the case management process which shall include: Assessment Defines role and scope of activities to the patient in a comprehensible manner. Communicates to the patient that the information gathered will be shared with the payer. Gathers consent for case management activities. Determines individual needs based on an assessment that identifies all significant needs related to the Medical condition and care (current diagnosis - primary and secondary, treatment plan and prognosis, projected length of treatment/anticipated cost, physicians - primary and specialists, significant history - patient and family, response to previous treatment, potential problems and complications, patient understanding of diagnosis and prognosis, experimental/controversial treatment, anticipated location of care, medications, need for equipment/supplies/etc., need for ancillary services), the Psychosocial condition and care (language, cultural influences, support systems and significant others, financial status, coping behaviors, compliance issues, living arrangements, home environment, religious beliefs, advance directives, patient goals/plans/wishes, teaching needs, transportation issues, ability to perform self-care), the Vocational situation (current vocational status, training/education, desire to return to work, job description, transferable skills, general interests/talents, wage earning abilities), the Payer issues (benefit plan design, PPO'S, policy limits/exclusions, eligibility for additional resources, ability to go outside of policy limits, laws affecting coverage, payer contact), available community resources, and barriers to effective outcomes. Works in a holistic manner, considering both medical and psychosocial issues. Identifies issues that might interfere with the provision of the highest quality, most appropriate, cost-effective care. Keeps in mind that a thorough, objective assessment is necessary to a successful outcome. Planning and Coordination: Creates an individualized plan of action based on the assessment which facilitates the coordination of appropriate and necessary treatment and services required by the patient. Gives consideration, in developing the plan, to the benefit plan design/coverage options. Sets appropriate, measurable goals. Provides the patient with information to make "informed" decisions, empowering and encouraging the patient to make his own decisions through including him in the planning process. Develops contingency plans Facilitates communication of the patient's wishes to all members of the health care team. When appropriate, discusses advanced directives. Obtains the acceptance of all parties (patient, family, payer, and providers) prior to instituting the plan. Develops a plan which advocates for the patient and maximizes benefit dollars. Researches and includes costs of services and use of community resources in plan design. Implementation and Monitoring: Implements a plan that is based on the assessment. Skillfully negotiates and coordinates care based on the plan developed. Identifies and coordinates resources to ensure success of the plan. Works within the plan network as possible. Refers to only those providers that are familiar or researched to ensure high quality (either through personal knowledge/experience, onsite inspections, conversations with providers, review of accreditations and credentials, networking with other case managers, review of outcomes, statistics, payer, and patient satisfaction). Monitors the provision of the coordinated plan. Reviews the care plan for compliance with standards of care and coordinates physician review when needed of procedures, medications, and care plans to ensure that services are medically necessary and consistent with care standards and health plan language. Appropriately communicates the outcome of medical necessity reviews per policy. Evaluation Evaluates plan on a regular basis to determine effectiveness, patient satisfaction, provider comfort, payer satisfaction, if the plan is meeting the needs of all involved parties (but most particularly-the patient's needs) cost effectiveness, patient compliance with treatment, and the impact on the patient's quality of life. Determines if revisions are required due to changes in medical condition, family status, insurance coverage, etc. Maintains availability and willingness to revise the plan as needed. Continues involvement as active, effective case manager. Maintains well-organized, objective, factual, clear, and concise documentation that reflects what was done on the cases and why it was done, adhering to policies regarding timeliness. Documentation of the plan must include who, what, where, when why and costs. Teaching of the patient and family is documented. Performs as a patient advocate, in an ethical manner at all times, incorporating case management concepts and following industry standards and guidelines. Becomes involved in the case management process as early as possible following the onset or diagnosis and maintains involvement throughout the course of the illness or injury (not just episodically), managing a case along the entire spectrum of care (home care, acute care hospital, subacute, rehabilitation, etc.), coordinating cost effective plans that provide quality and continuity of care while eliminating duplication of services and wasted benefit dollars. Demonstrates effective communication skills, both written and verbal, with all members of the treatment (physicians, providers, patients, families, significant others), employer, and payer team. Adheres to the Quality Assurance standards of the unit at a minimum of 85% of the time. Qualifications: 1. Active, unrestricted RN license in the state(s) of practice - Multi State license required. 2. Current certified case manager (CCM) credential preferred. 3. A minimum of three (3) years of clinical experience in maternity telephonic case management, facility case management or nurse navigator experience. Preferred clinical experience in bedside maternity nursing environment. 4. Ability to multi-task including navigation of multiple systems, multiple monitors, and have a conversation via telephone simultaneously. 5. Excellent time management and organizational skills, with the ability to maintain flexibility and work independently. Equal Employment Opportunity Policy Statement Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.

About Lucent Health Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers. Company Culture We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health. Honest Transparent Communication: be open and clear in all interactions without withholding crucial information Integrity: ensure accuracy in reporting, work outputs and any tasks assigned Truthfulness: provide honest feedback and report any issues or challenges as they arise Trustworthiness: build and maintain trust by consistently demonstrating reliable behavior Ethical Fair Decision Making: ensure all actions and decisions respect company policies and values Accountability: own up to mistakes and take responsibility for rectifying them Respect: treat colleagues, clients and partners with fairness and dignity Confidentiality: safeguard sensitive information and avoid conflicts of interest Hardworking Consistency: meet or exceed deadlines, maintaining high productivity levels Proactiveness: take initiative to tackle challenges without waiting to be asked Willingness: voluntarily offer to assist in additional projects or tasks when needed Adaptability: work efficiently under pressure or in changing environments Summary The Case Manager shall work with the entire team to provide appropriate, comprehensive, and proactive onsite and telephonic case management services and to promote the provision of only the highest quality, most appropriate, cost-effective healthcare to plan participants with chronic or catastrophic illnesses or injuries, in accordance with applicable laws, the CCM/CMSA Standards of Practice, the policies and procedures according to the AAHC/URAC Guidelines. Experience and certification in diabetes management (such as Certified Diabetic Educator) is a strong preference for this role. The right candidate will be an RN with a CDE certification, or an RN with experience managing diabetes and willing to obtain a CDE certification Responsibilities: The Case Manager, under the direction and supervision of a Certified Case Management (CCM) Professional and acting in a Patient Advocate capacity and according to AAHC/URAC standards, shall perform all phases of the case management process, which shall include: Defines role and scope of activities to the patient in a comprehensible manner. Communicates to the patient that the information gathered will be shared with the payer. Gathers consent for case management activities. Determines individual needs based on an assessment that identifies all significant needs related to the Medical condition and care Works in a holistic manner, considering both medical and psychosocial issues. Identifies issues that might interfere with the provision of the highest quality, most appropriate, cost-effective care. Keeps in mind that a thorough, objective assessment is necessary to a successful outcome. Creates an individualized plan of action based on the assessment, which facilitates the coordination of appropriate and necessary treatment, and services required by the patient. Gives consideration, in developing the plan, to the benefit plan design/coverage options. Sets appropriate, measurable goals. Provides the patient with information to make "informed" decisions, empowering and encouraging the patient to make his own decisions through including him in the planning process. Develops contingency plans. Develops a plan, which advocates for the patient and maximizes benefit dollars. Researches and includes costs of services and use of community resources in plan design. Implements a plan that is based on the assessment. Skillfully negotiates and coordinates care based on the plan developed. Identifies and coordinates resources to ensure success of the plan. Works within the health plan provisions. Refers to only those providers that are familiar or researched to ensure high quality (either through personal knowledge/experience, onsite inspections, conversations with providers, review of accreditations and credentials, networking with other case managers, review of outcomes, statistics, payer, and patient satisfaction). Monitors the provision of the coordinated plan. Evaluates plan on a regular basis to determine effectiveness, patient satisfaction, provider comfort, payer satisfaction, if the plan is meeting the needs of all involved parties (but most particularly-the patient's needs) cost effectiveness, patient compliance with treatment, and the impact on the patient's quality of life. Determines if revisions are required due to changes in medical condition, family status, insurance coverage, etc. Qualifications: Registered Nurse with a minimum of 5 years Clinical Experience Credentials such as CCM/CRRN, OCN or other pertinent certifications (preferred) Excellent written, telephone, and computer skills Positive, proactive, team-oriented approach/attitude Time management and organizational skills, flexible, with the ability to work independently Active, unrestricted multi-state license Recent clinical experience Preferred : Certified Diabetic Educator Equal Employment Opportunity Policy Statement Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.