Case Manager jobs at Sun Life of Canada - 491 jobs

The Telephonic Case Manager RN in Medical Oncology provides remote nursing support by coordinating patient care, educating members, and ensuring adherence to treatment plans. This role involves assessing patient health, identifying barriers, and connecting patients with necessary resources to improve health outcomes. Working primarily via telephone, the position requires strong clinical expertise, communication skills, and proficiency in healthcare technology systems. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today! The Telephonic Case Manager RN Medical/Oncology will identify, coordinate, and provide appropriate levels of care. The Telephonic Case Manager RN Medical/Oncology is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. This is a full-time, Monday - Friday, 8am-5pm position in your time zone. You'll enjoy the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Make outbound calls and receive inbound calls to assess members current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self-management Make referrals to outside sources Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. Solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN license in state of residence Active Compact RN License or ability to obtain upon hire 3+ years of experience in a hospital, acute care or direct care setting Proven ability to type and have the ability to navigate a Windows based environment Have access to high-speed internet (DSL or Cable) Dedicated work area established that is separated from other living areas and provides information privacy Preferred Qualifications BSN Certified Case Manager (CCM) 1+ years of experience within Medical/Oncology Case management experience Experience or exposure to discharge planning Experience in a telephonic role Background in managed care *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: telephonic case management, oncology nurse, patient education, care coordination, medical management, healthcare advocacy, remote nursing, chronic disease management, UnitedHealth Group, RN license

We're seeking Board Certified Behavior Analysts (BCBAs) who are ready to make a meaningful impact while being supported every step of the way. Please Note: We do not provide training for BCBA certification. Applicants must already hold active BCBA certification. Our training program is designed to support certified BCBAs in excelling within our company. What We Offer Competitive Pay: $55-$80/hr Start Part-Time: Transition to full-time after 90 days Work Options: In-person or hybrid roles Structured 6-Month Training & Onboarding: Paid training program (13 hours across 6 months) to help you grow, connect, and thrive as part of our team Free Licensure in All States We Operate In: We'll cover the cost of your LBA so you can work across multiple states under our company Same Day Pay for flexibility Full-Time Benefits (after 90 days): Health, dental, vision, life insurance, 401K with match, PTO, holiday pay Growth Opportunities: Free CEUs, mentorship, leadership paths No Non-Compete / No Set Caseloads What You'll Do Conduct assessments & create behavior plans Supervise ABA programs and staff Support and train caregivers & RBTs Collaborate with a team of experienced BCBAs Requirements Active BCBA certification (required) Experience supervising RBTs/technicians Strong clinical and decision-making skills Growth mindset & cultural responsiveness Apply today and join a supportive team that values your expertise, flexibility, and professional growth.

We're seeking Board Certified Behavior Analysts (BCBAs) who are ready to make a meaningful impact while being supported every step of the way. Please Note: We do not provide training for BCBA certification. Applicants must already hold active BCBA certification. Our training program is designed to support certified BCBAs in excelling within our company. What We Offer Competitive Pay: $55-$80/hr Start Part-Time: Transition to full-time after 90 days Work Options: In-person or hybrid roles Structured 6-Month Training & Onboarding: Paid training program (13 hours across 6 months) to help you grow, connect, and thrive as part of our team Free Licensure in All States We Operate In: We'll cover the cost of your LBA so you can work across multiple states under our company Same Day Pay for flexibility Full-Time Benefits (after 90 days): Health, dental, vision, life insurance, 401K with match, PTO, holiday pay Growth Opportunities: Free CEUs, mentorship, leadership paths No Non-Compete / No Set Caseloads What You'll Do Conduct assessments & create behavior plans Supervise ABA programs and staff Support and train caregivers & RBTs Collaborate with a team of experienced BCBAs Requirements Active BCBA certification (required) Experience supervising RBTs/technicians Strong clinical and decision-making skills Growth mindset & cultural responsiveness Apply today and join a supportive team that values your expertise, flexibility, and professional growth.

The Telephonic Case Manager RN in Medical Oncology provides remote nursing support by coordinating patient care, educating members, and ensuring adherence to treatment plans. This role involves assessing patient health, identifying barriers, and connecting patients with necessary resources to improve health outcomes. Working primarily via telephone, the position requires strong clinical expertise, communication skills, and proficiency in healthcare technology systems. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today! The Telephonic Case Manager RN Medical/Oncology will identify, coordinate, and provide appropriate levels of care. The Telephonic Case Manager RN Medical/Oncology is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. This is a full-time, Monday - Friday, 8am-5pm position in your time zone. You'll enjoy the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Make outbound calls and receive inbound calls to assess members current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self-management Make referrals to outside sources Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. Solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN license in state of residence Active Compact RN License or ability to obtain upon hire 3+ years of experience in a hospital, acute care or direct care setting Proven ability to type and have the ability to navigate a Windows based environment Have access to high-speed internet (DSL or Cable) Dedicated work area established that is separated from other living areas and provides information privacy Preferred Qualifications BSN Certified Case Manager (CCM) 1+ years of experience within Medical/Oncology Case management experience Experience or exposure to discharge planning Experience in a telephonic role Background in managed care *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: telephonic case management, oncology nurse, patient education, care coordination, medical management, healthcare advocacy, remote nursing, chronic disease management, UnitedHealth Group, RN license

We're seeking Board Certified Behavior Analysts (BCBAs) who are ready to make a meaningful impact while being supported every step of the way. Please Note: We do not provide training for BCBA certification. Applicants must already hold active BCBA certification. Our training program is designed to support certified BCBAs in excelling within our company. What We Offer Competitive Pay: $55-$80/hr Start Part-Time: Transition to full-time after 90 days Work Options: In-person or hybrid roles Structured 6-Month Training & Onboarding: Paid training program (13 hours across 6 months) to help you grow, connect, and thrive as part of our team Free Licensure in All States We Operate In: We'll cover the cost of your LBA so you can work across multiple states under our company Same Day Pay for flexibility Full-Time Benefits (after 90 days): Health, dental, vision, life insurance, 401K with match, PTO, holiday pay Growth Opportunities: Free CEUs, mentorship, leadership paths No Non-Compete / No Set Caseloads What You'll Do Conduct assessments & create behavior plans Supervise ABA programs and staff Support and train caregivers & RBTs Collaborate with a team of experienced BCBAs Requirements Active BCBA certification (required) Experience supervising RBTs/technicians Strong clinical and decision-making skills Growth mindset & cultural responsiveness Apply today and join a supportive team that values your expertise, flexibility, and professional growth.

We're looking for a detail-oriented and proactive Case Management Specialist to join our team. This role is essential in supporting our agents and clients by ensuring accurate policy tracking and smooth communication. Key Responsibilities Perform data entry and maintain accurate records in our CRM system. Access and navigate insurance carrier websites to check policy statuses. Update CRM with current policy information and notes. Collaborate with agents and assist clients with questions regarding policies. Make outbound calls to carriers when needed to verify or resolve policy issues. Document all interactions and updates thoroughly. Communicate effectively via Microsoft Teams and other internal tools. Qualifications Familiarity with insurance carrier websites and processes. Comfortable making calls to carriers and handling inquiries professionally. Strong attention to detail and organizational skills. Proficient in Microsoft Teams and basic office software. Excellent communication skills (written and verbal). Ability to work independently and manage multiple tasks. Why Join Us? Opportunity to transition into a permanent or part-time role based on performance. Supportive team environment with training provided. We offer comprehensive benefits to full time employees including company paid medical, STD, LTD and life insurance; plus voluntary dental, vision, Life/AD&D insurance, 401(k) with company-matching, generous paid time off and much more. We encourage applicants of all ages and experience, as we do not discriminate on the basis of an applicant's age. ALL OFFERS OF EMPLOYMENT ARE CONTINGENT UPON PASSAGE OF A DRUG SCREEN AND BACKGROUND CHECK.

The Year for Growth, Opportunity and Flexibility Are you ready for a career change in 2021? At American Income Life, we are searching for ambitious individuals who are ready to build a successful career while also having a positive impact on the communities around them. American Income Life currently provide supplemental insurance coverage to labor unions, credit unions and associations in 49 states, the District of Columbia, Canada and New Zealand. Why We Stand Out American Income Life provides supplemental insurance coverage to labor unions, credit unions and associations in 49 states, the District of Columbia, Canada and New Zealand. Requirements: Excellent communication skills Basic computer knowledge Work ethics Outgoing, fun & energetic with an upbeat personality Time management skills Pass a criminal background check Job Benefits: Full Benefits Paid weekly ($70,000 - $75,000 1st year average) Bonuses Health Insurance Reimbursement Life Insurance Flexible Schedule Retirement Plan American Income Life has served working class families since 1951 with life, accident, and supplemental health products to help protect members of labor unions, credit unions, associations, and their families. AIL representatives develop long-term relationships with clients and meet them where they are most comfortable: their homes Powered by JazzHR

Compliance Counsel is responsible for developing a comprehensive understanding of the Compliance Department operations, with the potential of overseeing and managing the Compliance Department. Managing and overseeing compliance activities for all states in which the company operates. Responsibilities also include providing compliance direction to licensed attorneys and other legal professionals, promptly identifying and implementing new compliance requirements as they arise, maintaining FSL's regulatory compliance for its insurance products and services sold through appropriately licensed agents and administrators, and other duties as may be assigned. Expectations Individual shall timely perform legislative reviews and monitoring of all laws and regulatory changes that impact compliance and procedures for the products and services provided by FSL/FTJ and its affiliates and promptly communicate all such applicable updates to affected departments. Examples include, but are not limited to, Health Care Reform, mandated benefits, annuity/senior suitability, state prompt pay/claims settlement practices/appeal procedures, state guarantee association notices, state complaint notification requirements, minimum health standards laws, life insurance replacement, interest on death proceeds, and agent and administrator requirements. Anti - Money Laundering. Responsibilities include maintaining AML procedures, coordinating with accounting, claims and customer service departments, agent communications including standards of payment, red flags, producer's guide, verification of prior AML training, coordination with human resources department for the AML training for home office personnel, and coordination of annual AML testing requirements. Duties also include assuring AML compliance of individual cash value life and annuity products, periodic review and update of corporate AML policy and procedures, coordination of annual AML testing with corporate Audit, as well as coordination and documentation of periodic SDN and FinCEN searches with IT department. Standard Practice Memorandums (SPM) and Compliance Bulletins. Research and update SPMs to incorporate legislative changes. Draft and coordinate distribution of compliance bulletins. Product Evaluation. Assist marketing and product control in the evaluation of new products/ideas and identify regulatory and filing issues that may impact the programs. Life/annuity/financial product line compliance, which includes legal support and assistance to (i) marketing and product control for new product analysis and development, and (ii) contracts department for existing product updates, new product contract drafting and project implementation, and objections on product filings. NAIC Best Interest Annuity Suitability Compliance - Review and recommend updates to NAIC Best Interest Annuity Suitability and related state Supervision System including: (i) Procedures to inform producers of the Best Interest rules requirements; (ii) Producer training manuals/materials/ and communications; (iii) Product specific promotional materials and agent training; (iv) New business process to assure all applicable forms and suitability review completed prior to issue; (v) Procedures to review recommendations; (vi) Annual reporting to states and senior management. Advertising Review and Marketing Compliance Support. Assist marketing department with developing agent training, client presentations and advanced markets sales concepts, advertising and website review, and recommendations and approval for regulatory compliance. Policy Filing Support. Provide assistance to the contracts department when requested. Monitor and communicate changes to policy form and rate filing requirements and procedures in the various states. Claims Support. Research and respond to claims questions regarding mandated benefits, prompt pay statutes, interest, subrogation, etc. Market Conduct. Review and evaluation of market conduct issues when requested. General Regulatory Compliance - Provide legal support and guidance regarding the following: (i) Life Underwriting developments including genetic information, AIDs, Search Engines; (ii) NAIC Lost Policyholder reporting; (iii) Life Claims questions related to prompt pay, interest, child support, rescissions; (iv) Licensing appointment, policies and procedures, controls and producer oversight; (v) Assist with Periodic Reporting. Competencies Strong management skills. Exceptional verbal and written communication, interpersonal, problem-solving, analytical, oral presentation, and organizational skills. Requisites Juris Doctor and attendant Bachelor of Arts or Bachelor of Science degrees. 7+ years of industry experience in annuities and interest sensitive life products. 3+ years of management experience (functional and personnel). We offer comprehensive benefits to full-time employees including company-paid medical, STD, LTD and life insurance; plus voluntary dental, vision, life/AD&D insurance, 401(k) with company matching, generous paid time off and much more. We encourage applicants of all ages and experience, as we do not discriminate on the basis of an applicant's age. ALL OFFERS OF EMPLOYMENT ARE CONTINGENT UPON PASSAGE OF A DRUG SCREEN AND BACKGROUND CHECK.

🚨 Now Hiring: RN Case Manager - Los Angeles, CA Region 🚨 💻 Work from home + local field travel 💰 Salary: $87,000 - $101,393 annually 💰 Salary: Competitive & commensurate with experience 🎉 Quarterly Bonus Opportunities 📚 Free CEUs for licenses & certificates 💳 License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! ✨ RN degree required ✨ National Certification preferred (CCM, CRC, COHN, CRRC) ✨ Workers' Comp Case Management experience a plus 📍 Location Requirement Candidates must be based in one of these California areas: Riverside, Rancho Cucamonga, Pomona, San Bernardino and Chino. ✅ Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the community! 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-RG1 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.

🚨 Now Hiring: RN Case Manager - New York 🚨 💻 Work from home + local field travel 💰 Salary: $90,000 - $92,000 annually 🎉 Quarterly Bonus Opportunities 📚 Free CEUs for licenses & certificates 💳 License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! ✨ RN degree required ✨ National Certification preferred (CCM, CRC, COHN, CRRC) ✨ Workers' Comp Case Management experience a plus 📍 Location Requirement Candidates must be based in one of these New York areas: Poughkeepsie, Newburgh, and Middletown. ✅ Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the community! 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. 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

🚨 Now Hiring: RN Case Manager - Sioux Falls, SD Region 🚨 💻 Work from home + local field travel 💰 Salary: Competitive & commensurate with experience 🎉 Quarterly Bonus Opportunities 📚 Free CEUs for licenses & certificates 💳 License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! ✨ RN degree required ✨ National Certification preferred (CCM, CRC, COHN, CRRC) ✨ Workers' Comp Case Management experience a plus ✅ Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the Sioux Falls community! Responsibilities 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 injured worker/disabled individual, physician and employer. Coordinates return to work with injured worker/disabled individual, 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 case management goals to include 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 and Company 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. Qualifications 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. 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-RG1

🚨 Now Hiring: RN Case Manager - Lubbock, TX Region 🚨 💻 Work from home + local field travel 💰 Salary: Competitive & commensurate with experience 🎉 Quarterly Bonus Opportunities 📚 Free CEUs for licenses & certificates 💳 License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! ✨ RN degree required ✨ National Certification preferred (CCM, CRC, COHN, CRRC) ✨ Workers' Comp Case Management experience a plus ✅ Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the Lubbock community! 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. 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

The Medical Case Management Manager (Manager, Enhanced Case Management (ECM)) leads the development, delivery, and continuous improvement of the ECM program, ensuring high quality care coordination and advocacy for member with complex health needs. This role provides direct leadership and mentorship to the ECM team, evaluates and enhances departmental workflows, and fosters strong internal and external partnerships through exceptional communication and relationship building skills. The Manager maintains expertise in self funded benefits administration and government programs such as Medicare and Medicaid to guide members in understanding and optimizing their available coverage options. In addition to managing a limited caseload, the position addresses client inquiries, resolves member escalations, and collaborates with organizational leadership to strengthen program strategy, performance, and impact. ESSENTIAL FUNCTIONS Develops and directly manages Enhanced Case Management Advocates and Supervisors, while providing indirect oversight to the Case Managers through supervisory staff. Monitors department dashboards and conducts case audits to ensure teams consistently meet or exceed quality standards and KPIs. Fosters a collaborative, continuous improvement environment and supports staff in resolving challenges and enhancing performance through constructive, supportive feedback. Engage with the Client Management and Value Team to offer insight related to high-dollar claimants and provide a clear explanation of ECM strategies, efforts, and impact. Identify members from our ASO Self-Funded and Co-Sourcing Partially Self-Funded Clients based on current medical condition(s), future claim costs, and current financial assessment for Enhanced Case Management evaluation and identify strategic solutions. Maintain continuous knowledge of Medicare, Medicaid, and other government programs, including application processes, eligibility criteria, dual eligibility, and coordination of benefits (COB). Identify trends and opportunities to collaborate with Medical Management leadership to enhance processes and strategies to improve quality, efficiency, and outcomes. Manage a case load of high-complexity members to support their needs, evaluate coverages and offer resources. Promotes an environment of continuous improvement and collaboration and assists in troubleshooting and resolving escalated challenges quickly by utilizing an empathetic approach. Coordinate with Client Management and other internal departments to answer questions and resolve client challenges. Assist in selecting and building the right teams to meet long-term talent planning needs and achieve business goals. Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent. Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed. Actively engage, coach, counsel and provide timely, and constructive performance feedback. Performs other related duties as assigned. EDUCATION Bachelor's degree or equivalent work experience required. EXPERIENCE AND SKILLS At least 5 years of Case Management experience, preferably from a third-party administrator, carrier, or within the healthcare industry required. At least 3 years at a supervisor level and successfully demonstrated leadership competencies required. Demonstrated expertise in Medicaid, Medicare, eligibility processes, and coordination of benefits. Experience managing teams of employees with a variety of backgrounds and tenure. Ability to monitor and prioritize multiple deadlines and projects simultaneously. Experience reading, analyzing, and reviewing organizational metrics and data, preferred. Comfortable managing competing priorities and guiding others in a fast-paced environment. Excellent written and verbal communication skills with the ability to influence cross-functionally and present to clients/leadership Proven experience building training programs, conducting audits, and providing structured feedback. POSITION COMPETENCIES Accountability Communication Action Oriented Timely Decision Making Building Relationships/Shaping Culture Customer Focus PHYSICAL DEMAND This is a standard desk role long periods of sitting and working on a computer are required. WORK ENVIRONMENT Remote Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive. The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend. Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role. Protect Yourself from Hiring Scams Important Notice About Our Hiring Process To keep your experience safe and transparent, please note: All interviews are conducted via video. No job offer will ever be made without a video interview with Human Resources and/or the Hiring Manager. If someone contacts you claiming to represent us and offers a position without a video interview, it is not legitimate. We never ask for payment or personal financial information during the hiring process. For your security, please verify all job opportunities through our official careers page: Current Career Opportunities at Allied Benefit Systems Your security matters to us-thank you for helping us maintain a fair and trustworthy process!

🚨 Now Hiring: RN Sr Case Manager - San Antonio, TX Region 🚨 💻 Work from home + local field travel 💰 Salary: Competitive & commensurate with experience 🎉 Quarterly Bonus Opportunities 📚 Free CEUs for licenses & certificates 💳 License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! ✨ RN degree required ✨ National Certification preferred (CCM, CRC, COHN, CRRC) ✨ Workers' Comp Case Management experience a plus ✅ Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the San Antonio community! Responsibilities 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 injured worker/disabled individual, physician and employer. Coordinates return to work with injured worker/disabled individual, 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 case management goals to include 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 and Company 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. Qualifications 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. 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-RG1

An ECM Coordinator supports department staff with administrative tasks related to a member's medical condition(s), department case work, communication with internal and external stakeholders, and manage audits. This role will engage with members to offer support and resources related to their medical condition(s) through Allied Care. ESSENTIAL FUNCTIONS Facilitate reviews, referrals, and outreach for referral-based proprietary strategies as well as engaging with members across Medical Management products Document all engagement accurately and concisely within the Microsoft Customer Relationship Management (CRM) system Manage escalated and time sensitive case management questions received from members, broker relationships, and internal and external Allied stakeholders Collaborate with strategic vendor partners to provide supportive services and support to members Lead and facilitate claims auditing in conjunction with ECM Coordinators. Complete department auditing related to daily tasks to ensure accuracy and identify escalations Identify impactful scenarios through appropriate closing summaries in timely fashion. Share impactful scenarios with the department's leadership team to deliver to internal departments, such as Sales, Operations, and Executive leadership Identifying escalations for department leadership team, as appropriate Other duties as assigned EDUCATION Bachelor's Degree or equivalent work experience, required EXPERIENCE AND SKILLS At least 3-5 years of administrative support experience required. Focus on patient-provider engagement, needs assessments, coordination of care, and or patient treatment adherence within the healthcare or social service industry preferred Understanding of intermittent medical terminology such as CPT, HCPC, and diagnostic codes Understanding of basic benefit plan design terminology such as deductible, out-of-pocket, prescription drugs, physical medicine services, etc. Strong verbal and written communication skills Strong analytical and problem-solving skills COMPETENCIES Communication Customer Focus Accountability Functional/Technical Job Skills PHYSICAL DEMANDS This is a standard desk role - long periods of sitting and working on a computer are required. WORK ENVIROMENT Remote Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive. The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend. Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role. Protect Yourself from Hiring Scams Important Notice About Our Hiring Process To keep your experience safe and transparent, please note: All interviews are conducted via video. No job offer will ever be made without a video interview with Human Resources and/or the Hiring Manager. If someone contacts you claiming to represent us and offers a position without a video interview, it is not legitimate. We never ask for payment or personal financial information during the hiring process. For your security, please verify all job opportunities through our official careers page: Current Career Opportunities at Allied Benefit Systems Your security matters to us-thank you for helping us maintain a fair and trustworthy process!

🚨 Now Hiring: RN Case Manager - Indianapolis, IN Region 🚨 💻 Work from home + local field travel 💰 Salary: Competitive & commensurate with experience 🎉 Quarterly Bonus Opportunities 📚 Free CEUs for licenses & certificates 💳 License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! ✨ RN degree required ✨ National Certification preferred (CCM, CRC, COHN, CRRC) ✨ Workers' Comp Case Management experience a plus ✅ Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the Indianapolis community! 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. 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

Now Hiring: RN Case Manager - Indianapolis, IN Region Work from home + local field travel Salary: Competitive & commensurate with experience Quarterly Bonus Opportunities Free CEUs for licenses & certificates License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! RN degree required National Certification preferred (CCM, CRC, COHN, CRRC) Workers' Comp Case Management experience a plus Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. Apply today and make an impact in the Indianapolis community!

This is an RN position that specifically requires experience in STI, PrEP/PEP clinical care with an interest in supporting programmatic STI, PrEP/PEP services. Reporting to the Case Manager Supervisor and/or their designee, the Medical Case Manager is responsible for providing daily care coordination, case management, and direct patient care. This position works with HIV/AIDS and Hepatitis-C infected individuals. The incumbent will work as part of an interdisciplinary care team including, but not limited to, coordinating patient services such non- medical case management, mental health and substance abuse treatment and integration of primary medical and specialty care. This position provides health education for patients with an emphasis on medication adherence and treatment compliance. This position works as part of the Integrated Behavioral Health Case Management team. Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC's executive management, community organizers, the general public, THC's patients, physicians, colleagues, assigned staff, vendors, contractors and consultants for the purpose of providing and exchanging information. Example of Essential Job Functions * Manages a caseload of patients * Ensures all intake assessments are completed * Ability to assess clients for needs related to treatment education, risk reduction and prevention. * Responsible for All new patients and employees are properly oriented to the unit (i.e. understand rules, policies, procedures, sign consent/release of information forms) * Responsible for developing, implementing and evaluating individualized patient care plans * Establishes long and short term goals for the patient which are S-M-A-R-T(Smart, Measurable, Achievable, Realistic, Timely) * Educates patients regarding the disease process and medications, methods for improving medication compliance, available community resources and other pertinent information. * Ensure the patients are linked to care management and staff adhere to appropriate lines of communication regarding the work being done with patients * Directs and monitors team members in implementing patient's care plan. * Maintains extensive knowledge regarding the current standards of HIV/AIDS care and case management processes. * Ensure quality care is delivered in an efficient and effective manner. * Ensure customer service standards are continuously demonstrated. * Engaging patients and their care givers in understanding and setting self-management plans in a culturally and linguistically appropriate manner. * Facilitates and coordinates services to develop patient-centered, individualized, integrated patient care plans, including self-management and outcomes goals. * Collaborate with various health care providers across the care continuum to ensure that patients are effectively managed and that health care needs are met. * Ensure that advance preparations for patients are coordinated for providers and with patients. * Participates in patient centered interdisciplinary care conferences and meetings as required. * Responsible for care in collaboration with the patient's physician, the patient and/or family representative, and other members of the professional staff * Acts as a liaison between patients, their families and healthcare providers * Providing clinical expertise for assigned patient population * Reassessing all treatment plans according to policy and as needed * Improve patients' quality of life through collaboration and follow up care * Facilitate collaboration between community health education resources and the patients * Assist patients with creating, monitoring and documentation of self-management goals and follow up with patients regarding set goals * Communicates to other team members regarding the status of patients' social and mental health needs * Monitor patients' use of health center services and the adequateness and effectiveness of the services utilized, including patient flow * Develops and maintains policies and procedures as required * Participates in professional development opportunities and attends staff/team meetings as deemed necessary * Documents in medical record per policy and standards * Maintains accurate and up-to-date records in a timely manner * Provides in-service training, and on-the-job training to new staff within the scope of service * Assist with audits and quality issues * Provide services in clinic within the scope of services of license as directed by Supervisory staff. * Facilitates referrals to specialty care and support services * Follows up on all medical care related referrals and documents all contact and outcome in the medical record. * Interacts with providers, including specialists, to ensure comprehensive care for the patients * Disseminates information and educates the provider community and patients regarding the latest treatment protocols in HIV/AIDS management. * Collaborates with ASOs and other community services in the Eligible Metropolitan Area (EMA), including specialty care providers, as necessary to ensure appropriate access to services and follow-up on the results to such referrals * Effectively tracks outcomes of care on an individual and aggregate basis regarding the patients * Monitors patients acuity level in an ongoing fashion to ensure transition to reduced intensity of services when patient is no longer an acuity level that necessitates medical case management. * Communicates with all team members about changes to level of services * Maintains information in a confidential manner in compliance with HIPAA and confidentiality policies and procedures. * Participation in required Ryan White staff meetings * Clinical coverage for direct patient care when needed * Performs other duties as assigned within the scope of license. Required Knowledge, Skills and Abilities Knowledge of FQHC operations, operating principles, guidelines and bylaws. Excellent leadership, customer service, organizational and presentation skills as well as the ability to effectively communicate THC's vision, and motivate others to achieve it organizationally, departmentally, and personally/professionally. Ability to communicate effectively (verbally and in writing). Ability to plan and organize work initiatives to successfully accomplish center/organizational goals and objectives. Ability to multi-task, prioritize and delegate as appropriate. Strong analytical, problem solving and interpersonal skills. Ability to identify, develop and implement short/long-term strategic goals and objectives. Ability to develop and maintain customer relationships; influence, build credibility and trust. Ability to think critically as well as apply critical thinking skills. Ability to: ensure and advocate for quality healthcare and services; and, lead and manage a diverse staff. Must have demonstrated knowledge of HIV/AIDS services in Maryland, along with an interest and ability to expand knowledge through training. Knowledge of the federal 340B program and its requirements. Licenses and Certifications RN License

Reporting to the Case Management Supervisor and/or their designee, the Non-Medical Case Manager is responsible for providing Non-Medical Case Management Services, that include EFA and Co-Morbidity Services and monitoring Ryan White eligibility. Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC's executive management, community organizers, the general public, THC's patients, physicians, colleagues, assigned staff, vendors, contractors and consultants for the purpose of providing and exchanging information. Example of Essential Job Functions * Manages a caseload of patients * Ensures all intake assessments are completed and assessments are reviewed semi-annually * Ability to assess clients for needs related to treatment education, risk reduction and prevention. * Responsible for all new patients are properly oriented to the unit (i.e. understand rules, policies, procedures, sign consent/release of information forms) * Responsible for developing, implementing and evaluating individualized patient care plans * Establishes long and short term goals for the patient which are S-M-A-R-T(Smart, Measurable, Achievable, Realistic, Timely) * Ensure the patients are linked to care management and staff adhere to appropriate lines of communication that promote team based and patient centered care * Ensure that advance preparations for patients are coordinated for providers and with patients. * Participates in patient centered interdisciplinary care conferences and meetings as required. * Acts as a liaison between patients, their families and healthcare providers * Improve patients' quality of life through collaboration and follow up care * Ensure customer service standards are continuously demonstrated. * Facilitate collaboration between community health education resources and the patients * Assist patients with creating, monitoring and documentation of self-management goals and follow up with patients regarding set goals, identify for needs assessment. * Effectively tracks outcomes of care on an individual and aggregate basis regarding the patients * Gathers and documents attempts to gather program eligibility information. * Assist with navigation in patients' use of health center services * Participates in professional development opportunities and attends staff/team meetings as deemed necessary * Documents in medical record per policy and standards * Provides in-service training, and on-the-job training to new staff within the scope of service * Maintains information in a confidential manner in compliance with HIPAA and confidentiality policies and procedures. * Performs other duties as assigned. * Travel is required Minimum Education, Training and Experience Required * AA Degree Required * Bachelor's Level Degree preferred One year Case Management experience preferred