Case Manager jobs at RiverSource

Pay Range: $73,500.00 - $110,300.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. What you will do: Manage members through evidence-based care, promoting access to the healthcare system, and assessing needs to identify appropriate interventions and support services as well as reduce barriers to evidence-based care. Member management includes, but is not limited to, conducting health assessments (telephonic and face-to-face) to identify high-risk or emerging risk members for education and intervention; evaluating and modifying action plans by working with members and collaborating with providers. Evaluate member services to ensure appropriate levels and coordination of care, including pre-authorization, concurrent review, quality-of-care screening, and discharge planning. Ensure member and provider satisfaction by demonstrating knowledge of member plan benefits and community resources. Identify opportunities to moderate claims costs for employer group and individual members. Promote and monitor use of wraparound service programs for optimal member experience while managing chronic and acute care needs. Facilitate communication between members, providers, and stakeholders to coordinate and implement action plans for improving members' total health. Provide continuity and consistency of care by building positive relationships between members, families, providers, care coordinators, social support partners, and the health plan. Engage in team operations including supervision, team huddles, staff meetings, case rounds, metric management, training opportunities, department initiatives, and projects. Work collaboratively to develop and implement solutions, identify barriers, and exemplify corporate values through accountability, collaboration, integrity, and respect. Perform other duties as assigned What you'll need to succeed: Unrestricted Rhode Island Nursing License Unrestricted Massachusetts Nursing License Three years' experience in a medical/clinical environment or managed health plan Must obtain Certified Case Manager (CCM) certification within three years of employment The extras: Bachelor's degree in nursing Certified Case Manager (CCM) Reside in Rhode Island or other Nurse Licensure Compact state (NLC) Bilingual Spanish, Portuguese Experience working in a managed care/health maintenance organization Experience implementing and upholding Quality, CMS, NCQA requirements Knowledge of utilization management and/or coordination of care Knowledge of population health and chronic condition management principles, aligning with corporate initiatives such as specialty within high-risk maternity and rising risk conditions such as diabetes, hypertension, COPD, etc. Understanding of health care delivery system access points and services Demonstration of successful (member) engagement via application of Motivational Interviewing techniques and health coaching Ability to navigate the healthcare delivery system Understanding of evidence-based care programs and approaches Strategic and critical thinking skills Strong analytical skills Strong business acumen Strong presentation negotiation, problem-solving, and decision-making skills Strong written and verbal communication skills Ability to work effectively with a wide variety of people in individual and group settings Strong organizing skills, with the ability to prioritize and respond to shifting deadlines Strong time management skills Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

• Great Work Life Balance! • Quarterly Bonus Opportunities! • Free CEU's for licenses and certificates • License and national certification reimbursement This is a work from home position requiring local field case management travel to cover the San Jose, California region. Salary details: $51,283 - $93,781/Annually RN degree required National Certification such as CCM, CRC, COHN, CRRC preferred Prior Workers Compensation Case Management preferred To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management. Responsibilities Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem solving by appropriate use of research and resources. May perform other related duties as assigned. Qualifications Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. Minimum of 1-3 years diverse clinical experience and one of the below: Certification as a case manager from the URAC-approved list of certifications (preferred); A registered nurse (RN) license. Must be compliant with state requirements regarding national certifications. General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. Excellent analytical and customer service skills to facilitate the resolution of case management problems. Basic computer skills including working knowledge of Microsoft Office products. Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees. Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes. Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously. Demonstrated leadership ability with a basic understanding of supervisory and management principles. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Must meet specific requirements to provide medical case management services. Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months. National certification must be obtained in order to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Must maintain a valid driver's license in state of residence. #LI-RG1

Charles Taylor is a highly successful global provider of professional services to the insurance industry. We are seeking an experienced Workers Compensation Field Case Manager to join our team in the Cincinnati-North Dayton-Columbus, OH area. This is a remote, contracted role. Job Summary The Field Case Manager is responsible for assisting our clients injured workers with case management and return to work services. Essential Duties and Responsibilities * Provide field case management services for our clients injured workers, including onsite attendance at doctor's appointments * Perform case assessments and develop action plans to support recovery and timely return to work * Coordinate timely access to needed medical services and maintain proactive communications * Cultivate excellent relationships with all parties (AE's, IWs, providers, clients) * Provide written reports on case status and updates (post, physician visit/weekly/monthly) and submits timely monthly billing to billing specialist. Contracted CM Requirements * Prior Field Case Management - workers' compensation experience preferred * Active Registered nurse (R.N. License and possess the ability to be licensed as a registered nurse in multiple states without restrictions) * Understanding and working knowledge of ODG Guidelines * Seasoned professional nurse with clinical nursing experience and at least 2-years case management experience with injured workers * Understanding of case management processes * Excellent interpersonal communication skills - both oral and written * Professional certifications such as: CDMS, CRRN, COHN, or CCM are a plus Values At Charles Taylor, our values define our identity, principles and conduct. This person will demonstrate and champion Charles Taylor Values by ensuring Agility, Integrity, Care, Accountability and Collaboration. AAP/EEO Statement Here at Charles Taylor we are proud to be an Inclusive Employer. We provide an environment of mutual respect with zero tolerance to discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex, or sexual orientation. Our external partnerships and the dedicated work we do in promoting a transparent and fair recruitment and selection process all contribute to the successful, inclusive, and diverse culture and environment which we are proud to be a part of at Charles Taylor.

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

AMERISAFE is seeking a detail-oriented, productivity driven professional to add to our Florida based Workers Compensation Claims Team. In this position, you will conduct on-site and in-person investigations, determine compensability, establish reserves, document decision making, issue benefit payments, and make notifications to the State administrative authority. You will work with injured workers, employers, medical and legal professionals to ensure the appropriate benefits are provided to injured workers under the appropriate Workers' Compensation Laws. In addition to the benefits listed on our careers page, other benefits of this position include: Salaried position based on location and experience ($50,000 to $95,000) Auto reimbursement program Reimbursement for cell phone and internet Target Case Load of 60 claims Upon an offer and acceptance of employment with AMERISAFE, you will be required to complete our pre-employment screening, which includes a criminal background check, a 10-panel drug test and, if applicable, a review of your motor vehicle report. A 10-panel drug test includes amphetamine/methamphetamine, barbiturates, benzodiazepines, cocaine metabolite (BZE), marijuana metabolite (THCA), methadone, methaqualone, codeine/morphine, phencyclidine, propoxyphene. Note - All positions that require driving for the company are considered safety-sensitive positions. Qualifications Workers Compensation Claims experience highly preferred. Bachelor's degree or related professional business experience acceptable. State license to handle Workers' Compensation claims if required. Professional written and verbal communication skills required. World class customer service attitude required. Ability to learn and use proprietary software and Microsoft Office products is necessary. The ability to be self-directed. This is a remote position. Valid driver's license, acceptable driving record and acceptable vehicle required. Frequent travel within a designated territory required, but rarely is overnight travel required.

* Great Work Life Balance! * Quarterly Bonus Opportunities! * Free CEU's for licenses and certificates * License and national certification reimbursement This is a work from home position requiring local field case management travel to cover the Sacramento, California region. * RN degree required * National Certification such as CCM, CRC, COHN, CRRC preferred * Prior Workers Compensation Case Management preferred To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management.

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

The Behavioral Health Case Manager for Transitions of Care is dedicated to proactive engagement with members admitted to Acute Inpatient Psychiatric facilities. This role involves coordinating care to address immediate behavioral health needs and overcoming barriers to discharge from inpatient care. The goal is to reduce readmissions and adverse events through patient education, support, and connection to outpatient services. To excel in this role, you should meet all licensing requirements, have experience in behavioral health within inpatient or outpatient settings, and be knowledgeable about strategies for effective care linkage, patient education, and reducing readmissions. This is a great opportunity for candidates seeking a hybrid role. For approximately three days a week, you will work remotely, conducting telephonic outreach to members. Two days a week, you will visit members in a local Acute Inpatient Psychiatric facility in the Murfreesboro area. It's important to note that the caseload is fluid, adapting to changes in facility admissions and referrals, and so schedule changes are a possibility. Due to location requirements, candidates must be within 25 miles of Murfreesboro, Tennessee. Job Responsibilities Supporting utilization management functions for more complex and non-routine cases as needed. Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs. Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits. Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation. Perform case management activities in community settings including face to face with members as required. Various immunizations and/or associated medical tests may be required for this position. Testing/Assessments will be required for Digital positions. Job Qualifications License Current, active unrestricted Tennessee license in Nursing (RN) or behavioral health field (Master's level or above) (Ph.D., LCSW/LMSW, LLP, MHC, LPC, etc.) required. RN may hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience 3 years - Clinical behavioral health / substance use disorder experience required 1 year - Must be knowledgeable about community care resources and levels of behavioral health care available. Skills\Certifications Currently has a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire. Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Independent, Sound decision-making and problem-solving skills Excellent oral and written communication skills Strong interpersonal and organizational skills Strong analytical skills Positive relationship building skills and ability to engage and motivate health behaviors in diverse populations Ability to quickly identify and prioritize member needs and provide structured and focused support and interventions Experience with Motivational Interviewing Techniques and Adult Learning Styles Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

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

AMERISAFE is seeking a detail-oriented, productivity driven professional to add to our Pennsylvania based Workers Compensation Claims Team. In this position, you will conduct on-site and in-person investigations, determine compensability, establish reserves, document decision making, issue benefit payments, and make notifications to the State administrative authority. You will work with injured workers, employers, medical and legal professionals to ensure the appropriate benefits are provided to injured workers under the appropriate Workers' Compensation Laws. In addition to the benefits listed on our careers page, other benefits of this position include: Salaried position based on location and experience ($50,000 to $95,000) Auto reimbursement program Reimbursement for cell phone and internet Target Case Load of 60 claims Upon an offer and acceptance of employment with AMERISAFE, you will be required to complete our pre-employment screening, which includes a criminal background check, a 10-panel drug test and, if applicable, a review of your motor vehicle report. A 10-panel drug test includes amphetamine/methamphetamine, barbiturates, benzodiazepines, cocaine metabolite (BZE), marijuana metabolite (THCA), methadone, methaqualone, codeine/morphine, phencyclidine, propoxyphene. Qualifications Pennsylvania workers compensation claims experience highly preferred. Bachelor's degree or related professional business experience acceptable. State license to handle Workers' Compensation claims if required. Professional written and verbal communication skills required. World class customer service attitude required. Ability to learn and use proprietary software and Microsoft Office products is necessary. The ability to be self-directed. This is a remote position. Valid driver's license, acceptable driving record and acceptable vehicle required. Frequent travel within a designated territory required, but rarely is overnight travel required.

AMERISAFE is seeking a detail-oriented, productivity driven professional to add to our Illinois based Workers Compensation Claims Team. In this position, you will conduct on-site and in-person investigations, determine compensability, establish reserves, document decision making, issue benefit payments, and make notifications to the State administrative authority. You will work with injured workers, employers, medical and legal professionals to ensure the appropriate benefits are provided to injured workers under the appropriate Workers' Compensation Laws. In addition to the benefits listed on our careers page, other benefits of this position include: Salaried position based on location and experience ($50,000 to $95,000) Auto reimbursement program Reimbursement for cell phone and internet Target Case Load of 60 claims Upon an offer and acceptance of employment with AMERISAFE, you will be required to complete our pre-employment screening, which includes a criminal background check, a 10-panel drug test and, if applicable, a review of your motor vehicle report. A 10-panel drug test includes amphetamine/methamphetamine, barbiturates, benzodiazepines, cocaine metabolite (BZE), marijuana metabolite (THCA), methadone, methaqualone, codeine/morphine, phencyclidine, propoxyphene. Qualifications Claims experience highly preferred. Bachelor's degree or related professional business experience acceptable. State license to handle Workers' Compensation claims if required. Professional written and verbal communication skills required. World class customer service attitude required. Ability to learn and use proprietary software and Microsoft Office products is necessary. The ability to be self-directed. This is a remote position. Valid driver's license, acceptable driving record and acceptable vehicle required. Frequent travel within a designated territory required, but rarely is overnight travel required.

• Great Work Life Balance! • Quarterly Bonus Opportunities! • Free CEU's for licenses and certificates • License and national certification reimbursement This is a work from home position requiring local field case management travel to cover the Los Angeles, California region. RN degree required National Certification such as CCM, CRC, COHN, CRRC required Prior Workers Compensation Case Management preferred To provide quality case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Quality Improvement Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability and Disability. Bachelor's Degree in a health-related field is preferred. Associates or diploma in nursing also accepted. Three years of Workers' Compensation case management with ability to independently coordinate a diverse caseload ranging in moderate to high complexity. Demonstrated ability to handle complex assignments and ability to work independently is required. Effective oral and written communication skills are required. Thorough understanding of jurisdictional WC statutes. Advanced knowledge to exert positive influence in all areas of case management. Advanced communications and interpersonal skills in order to conduct training, provide mentorship, and assist supervisor in general areas as assigned. Highly skilled at promoting all managed care products and services internally and externally. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Minimum of 1 nationally recognized Certification from the URAC list of approved certifications. Must be able to travel as required. Individuals who conduct initial clinical review possess an active, professional license or certification: To practice as a health professional in a state or territory of the U.S.; and With a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review. Must maintain a valid driver's license in state of residence. #LI-KE1 May assist supervisor/manager in review of reports, staff development. Reviews case records and reports, collects and analyzes data, evaluates client's medical and vocational status and defines needs and problems in order to provide proactive case management services. Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, quality assessment (QA) standards with a minimum of supervisory intervention. Facilitates a timely return to work date by establishing a professional working relationship with the client, physician and employer. Coordinates return to work with patient, employer and physicians. May recommend and facilitate completion of peer reviews and IME's by obtaining and delivering medical records and diagnostic films notifying patients. Manages cases of various product lines of at least 3-4 areas of service (W/C, Health, STD, LTD, Auto, Liability, TPA, Catastrophic, Life Care Planning). Specifically, the case manager should be experienced in catastrophic cases plus 2-3 additional types listed above. Renders opinions regarding case cost, treatment plan, outcome, and problem areas and makes recommendations to facilitate rehabilitation goals and RTW. May review files for claims adjusters and supervisors. May perform job site evaluations/summaries. Prepares monthly written evaluation reports denoting case activity, progress and recommendations in accordance with state regulations and company standards. May obtain referrals from branch claims office or assist in fielding phone calls for management as needed. Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services. Maintains contact with all parties involved on case, necessary for rehabilitation of the client. May spend approximately 70% of work time traveling to homes, health care providers, job sites, and various offices as required to facilitate return to work and resolution of cases. May meet with employers to review active files. Reviews cases with supervisor monthly to evaluate file and obtain direction. Upholds the Crawford Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem resolution by appropriate use of research and resources. May perform other related duties as assigned.

* Great Work Life Balance! * Quarterly Bonus Opportunities! * Free CEU's for licenses and certificates * License and national certification reimbursement This is a work from home position requiring local field case management travel to cover the areas of Santa Clarita, Lancaster, Palmdale, Burbank, Glendale, Porter Ranch, Valencia & Van Nuys, California. * RN degree required * National Certification such as CCM, CRC, COHN, CRRC required * Prior Workers Compensation Case Management preferred To provide quality case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Quality Improvement Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability and Disability.

AMERISAFE is seeking a detail-oriented, productivity driven professional to add to our Workers Compensation Claims Team based out of Kansas City, MO or Springfield, MO. In this position, you will conduct on-site and in-person investigations, determine compensability, establish reserves, document decision making, issue benefit payments, and make notifications to the State administrative authority. You will work with injured workers, employers, medical and legal professionals to ensure the appropriate benefits are provided to injured workers under the appropriate Workers' Compensation Laws. In addition to the benefits listed on our careers page, other benefits of this position include: Salaried position based on location and experience ($50,000 to $95,000) Auto reimbursement program Reimbursement for cell phone and internet Target Case Load of 60 claims Upon an offer and acceptance of employment with AMERISAFE, you will be required to complete our pre-employment screening, which includes a criminal background check, a 10-panel drug test and, if applicable, a review of your motor vehicle report. A 10-panel drug test includes amphetamine/methamphetamine, barbiturates, benzodiazepines, cocaine metabolite (BZE), marijuana metabolite (THCA), methadone, methaqualone, codeine/morphine, phencyclidine, propoxyphene. Note - All positions that require driving for the company are considered safety-sensitive positions. Qualifications Workers Compensation Claims experience highly preferred. Bachelor's degree or related professional business experience acceptable. State license to handle Workers' Compensation claims if required. Professional written and verbal communication skills required. World class customer service attitude required. Ability to learn and use proprietary software and Microsoft Office products is necessary. The ability to be self-directed. This is a remote position. Valid driver's license, acceptable driving record and acceptable vehicle required. Frequent travel within a designated territory required, but rarely is overnight travel required.

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

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

AMERISAFE is seeking a detail-oriented, productivity driven professional to add to our Pennsylvania based Workers Compensation Claims Team. In this position, you will conduct on-site and in-person investigations, determine compensability, establish reserves, document decision making, issue benefit payments, and make notifications to the State administrative authority. You will work with injured workers, employers, medical and legal professionals to ensure the appropriate benefits are provided to injured workers under the appropriate Workers' Compensation Laws. In addition to the benefits listed on our careers page, other benefits of this position include: Salaried position based on location and experience ($50,000 to $95,000) Auto reimbursement program Reimbursement for cell phone and internet Target Case Load of 60 claims Upon an offer and acceptance of employment with AMERISAFE, you will be required to complete our pre-employment screening, which includes a criminal background check, a 10-panel drug test and, if applicable, a review of your motor vehicle report. A 10-panel drug test includes amphetamine/methamphetamine, barbiturates, benzodiazepines, cocaine metabolite (BZE), marijuana metabolite (THCA), methadone, methaqualone, codeine/morphine, phencyclidine, propoxyphene. Note - All positions that require driving for the company are considered safety-sensitive positions. Qualifications Pennsylvania workers compensation claims experience highly preferred. Bachelor's degree or related professional business experience acceptable. State license to handle Workers' Compensation claims if required. Professional written and verbal communication skills required. World class customer service attitude required. Ability to learn and use proprietary software and Microsoft Office products is necessary. The ability to be self-directed. This is a remote position. Valid driver's license, acceptable driving record and acceptable vehicle required. Frequent travel within a designated territory required, but rarely is overnight travel required.

Purpose: The Reimbursement Case Manager (RCM) is a professional client facing role responsible for various functions, including accurate and timely response to client inquiries regarding specific referral status or escalation. The RCM serves as a primary point of contact for payers. The RCM will manage the benefits investigation process to determine patient eligibility and coverage per their plan along with prior authorization and appeal support. The RCM will interact indirectly with external clients such as manufacturers and specialty pharmacies as well as internal teams including Operations and Program Management. Responsibilities: Serve as primary point of contact for client and customer reimbursement inquiries and escalations. Coordinate investigation and determination of patient benefits with internal program operations, insurance plans, and specialty pharmacy liaisons. Review forms for completeness and communicate any missing information required to complete benefit verification process. Apply defined business rules to qualify patients for manufacturer supported programs. Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete benefits verification process, prescription coverage, authorization and appeal support, and answer any reimbursement related inquiries. Use high-level problem-solving skills to research cases and resolve independently using creativity, innovation, and professional judgement to make sound decisions. Leverages both electronic and telephonic benefit investigation tools to verify eligibility, coverage, authorization and appeal process, specialty pharmacy mandates, and cost differences. Maintain frequent phone contact with payers to gather all necessary information related to case/patient information, insurance coverage, and where applicable, prior authorization (PA) or appeals processing. Maintain clear, concise, and accurate documentation on all accounts according to Standard Operating Procedures. Independently and effectively verify coverage and proactively enroll eligible patients into the commercial copay program. Efficiently process patient and prescriber requests to accelerate access to therapy. Serve as operational expert on payer trends, product access, and reporting reimbursement insights and/or delays, i.e., denials, underpayment, access delays. Frequently communicate with program management on new insurance requirements and trends. Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; escalate appropriately. Coordinate and collaborate with internal team members to provide reimbursement information to manufacturer representatives, HCP offices and other key personnel. Strong compliance mindset, demonstrating clear understanding of patient privacy laws. Active participation in building and maintaining respectful, collaborative internal/external team relationships, exercising, and encouraging positivity. This position may require flexibility in scheduling, with shifts occurring between 8:00AM and 8:00PM EST, Monday through Friday. Employees should be prepared to work within this timeframe as needed. Other duties as assigned. Required Qualifications: High school diploma plus 2+ years recent reimbursement experience Previous 2+ years of experience in a pharmacy, healthcare setting and/or pharmacy/medical insurance background Advanced knowledge and experience in healthcare setting Experience with benefit investigation and verification of prescription benefits Ability to communicate effectively both orally and in writing with a focus on customer satisfaction Ability to independently manage case load, prioritize work, and use time management skills to meet deliverables Empathy, drive, and commitment to exceptional service Strong analytical and organizational skills with attention to detail Ability to work flexible schedule per Program business needs Strong interpersonal skills; possess effective oral and written communication skills Possess a strong understanding of biologic/specialty pharma market and patient access challenges Ability to leverage professional expertise Apply company policies and procedures to resolve challenges Preferred Qualifications: Undergraduate Degree and/or equivalent work experience Certified Pharmacy Technician (CPhT) Understanding of plan types - Government, Commercial, Medicaid, VA, Fed Knowledge of insurance structure (ex PBM's, major medical plans, co-pay assistance /cards) Experience with benefit investigation and verification of prescription benefits Working Knowledge of Third-Party and other Foundation programs Basic understanding of Co-Pay Assistance (if applicable) Understanding of HUB patient journey, workflow, and triage is a plus Ability to proficiently use Microsoft Teams, Excel, Outlook, and Word Strong analytical and organizational skills with meticulous attention to detail Work Environment: RareMed offers a hybrid work structure, combining remote work and in-office requirements. The frequency of onsite requirements will vary depending on role, operational needs, meetings, client visits, or team collaboration activities. Employees must be within commuting distance to Pittsburgh, PA, and able to report to the office when needed. We will provide advance notice when possible. This role routinely involves standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting, employees must have reliable internet access to utilize required systems and software required for the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change while working from home. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, lighting, comfortable temperature, furniture, etc. Employee's teleworking space should be separate and distinct from their “home space” and allow for privacy. Physical Demands:While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.

Job Details Remote - Corp - Tustin, CA Full Time $22.00 - $24.00 Hourly Day Join Liberty Dental Plan as a Case Management Coordinator, making a real impact in your Arizona community by helping members access the dental care they need. The Case Management Coordinator provides confidential, unbiased assistance to Liberty Dental Plan Medicaid enrollees in need of dental services who also have co-morbid special health care needs. The CMC supports enrollees by facilitating access to dental benefits, resolving barriers to care, and collaborating across divisions and external organizations to ensure holistic, quality service delivery. 📍 Location Requirement: Candidates must live in Arizona Essential Duties & Responsibilities Inform enrollees of available covered dental benefits. Assist enrollees in resolving conflicts and barriers to obtaining dental care. Support enrollees in securing dental services and provide education on their rights and responsibilities. Guide enrollees in accessing Liberty's complaints, appeals, and grievance processes. Document cases and events accurately in Health Solutions Plus (HSP). Manage telephone and email inquiries regarding services, dissatisfaction, and second opinions. Educate enrollees on the Liberty Care Coordination Program. Research and respond to inquiries, providing comprehensive written responses as needed. Meet required turnaround times for cases and inquiries through various communication channels. Collaborate effectively in a remote work environment with internal teams such as Member Services, Provider Relations, Claims, Grievances, Staff Dentists, and Leadership. Interface with external entities including dental offices, health plan care coordinators, transportation vendors, hospitals, and community organizations. Perform other duties as assigned. Education & Experience Requirements Associate degree or equivalent years of administrative experience required. 2+ years of experience in dental field preferred; insurance experience highly desired. Registered Dental Hygienist (RDH) or Registered Dental Assistant (RDA) certification is a plus. Proficient in Microsoft Excel, Word, and Outlook. Strong verbal and written communication skills with the ability to compose comprehensive responses. Strong critical thinking and problem-solving skills. Excellent customer service and interpersonal skills. Ability to work independently and collaboratively in a remote environment. Bilingual in Spanish preferred (must be able to pass a dental terminology exam if applicable). Knowledge of medical terminology preferred. Location Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States. What Liberty Offers Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That's why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity. Our first-class benefits package supports employees and their dependents with: Competitive pay structure and savings options to help you reach your financial goals. Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines. Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan. 100% employer-paid dental coverage for employees and eligible dependents. Vision insurance with low-cost premiums for employee-only coverage and dependents. Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage. Flexible Spending Accounts for healthcare and dependent care expenses. Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance. Long-term disability coverage. Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts. Employee Assistance Program (EAP) to support mental health and well-being. Generous vacation and sick leave policies, with the ability to roll over unused time. 10 paid company holidays. Tuition reimbursement for eligible educational expenses. Remote or hybrid work options available for various positions. Compensation In the spirit of pay transparency, the base salary range for this position is $22.00 - $24.00 hourly, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions. Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth. Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements. Sponsorship and Relocation Specifications Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time.