Case Manager

Job not on LinkedIn

🔥 4 minutes ago

🐊 Florida, North Carolina – Remote

🐊 Florida – Remote 🌲 North Carolina – Remote

💵 $35 - $38 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 1%

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Independent Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🛡️ Insurance

Healthcare • Healthcare Insurance • Insurance

Independent Health is one of Western New York's first Health Maintenance Organizations (HMOs) and provides health insurance coverage to approximately 355,000 individuals with over 100 plans, services, and products. The company specializes in health insurance, pharmacy benefits, Medicare Advantage, and self-funded plans, promoting a culture that emphasizes bringing out the best in its members and staff.

📋 Description

• Apply the six essential case management activities: assessment, planning, implementation, coordination, monitoring and evaluation • Assess patients’ immediate and long-term social and medical needs • Develop and update patient-centered plans of care considering physical, psychosocial, benefit plan and cost-benefit factors • Monitor care quality, effectiveness and changing patient needs • Ensure regulatory, privacy, payment/reimbursement and appeal-process compliance • Coordinate decisions, documentation and maintain an accurate database • Establish relationships with interdisciplinary teams and communicate case objectives • Advocate for patients and identify potential complications • Apply the Americans with Disabilities Act and relevant federal legislation • Research community resources and help patients obtain applicable services • Identify and implement alternative care levels and resources, including rehabilitation and home health care • Evaluate quality and cost effectiveness with payors, providers and team members; negotiate discounts when appropriate • Apply case management, problem-solving, confidentiality and liability concepts • Document plans of care timely and analyze outcomes • Participate in professional organizations, continuing education, Nova training and education committees • Support staff orientation, training and provide guidance to support staff • Perform assignments professionally and practice within the scope of multi-state licensure

🎯 Requirements

• Registered Nurse (RN) with active, current, unrestricted license in a Nurse Licensure Compact (NLC) state required • Case Management Certification (CCM) required; candidates without CCM certification must obtain it within three years of commencing employment • Three years of clinical RN experience in a med/surg or ambulatory care setting required • Clinical experience in Behavior Health, Transplant, Neo-Natal or Oncology preferred • Previous experience in managed care a plus • Clinical knowledge of the health or social work needs for the population served • Ability to identify barriers to a successful care management path • Ability to interact effectively with physicians and other members of the health care team • Excellent problem-solving and time management skills • Excellent written, verbal and interpersonal communication skills • Ability to complete job duties independently and proficiently • Flexibility in work schedules and assignments • Proven examples of displaying Nova’s Core 4 • Immigration or work visa sponsorship will not be provided • Candidates must reside in North Carolina or Florida • Bachelor’s degree preferred

🏖️ Benefits

• First-class perks, benefits and a culture that fosters growth, innovation and collaboration • Scorecard incentive eligibility • Full range of benefits • Generous paid time off