1,197 Case Management jobs in the United States

Job Description

TITLE

Manager, Case Management

POSITION SUMMARY

Individual reports to the director of Clinical Operations for all operational issues and the AMM or SVP clinical operations for all clinical issues. The case management manager is critical to the success of AMM and as such is responsible for the implementation and ongoing management of all the AMM case management programs. The manager will provide guiding principles, interventions and strategies that are targeted at the achievement of client stability, wellness, and autonomy through advocacy, assessment, planning, communication, education, resource management, care coordination, collaboration, and service facilitation.

RESPONSIBILITIES-DUTIES

• Review Inpatient cases and provides guidance to IP case managers for reviews, hospital transfers, observation, discharge planning, and transitions of care.
• Review outpatient cases and provides guidance to OP case managers for reviews, case management program overview and following the processes for disease management, complex case management and the management of DSNP.
• Responsible for inspiring the team to come up with creative ways to keep patients out of the hospital and have the best quality of care at home or in a care facility. Lead Monday nurse team meetings.
• Identifies, develops, and oversees the educational needs of the team and motivates and leads the team in setting and reaching goals for improvement.
• Work with the team to enhance the systems case management use.
• Involved in the projects for the platform development for case management.
• Recruits and retains CM team members.
• Conducts annual performance appraisals.
• Provides coaching and disciplinary activities with staff.
• Participates in budget preparation if needed.
• Analyzes staffing ratios and productivity levels.

EDUCATION AND EXPERIENCE REQUIREMENTS

• Have deep compassion for patients and the care they receive.
• Valid California RN or LVN license
• Bachelor’s degree strongly preferred, master’s degree in nursing or health – Related Major preferred.
• CCM desirable
• Minimum of 5 years of UM and CM experience in an IPA/PMG or HMO setting or equivalent education combined with experiences in direct patient care settings such as SNF or inpatient settings
• Experience in management (hiring, counseling, terminations) strongly preferred
• Maintains confidentiality and adheres to HIPAA policies.
• Managerial skills necessary to independently manage on-site as well as remote teams.

Job Description

Summary: The Medical Case Management Nurse (MCM Nurse) provides a variety of services with respect to medical care review, cost containment, claims review, appeals and grievances, and analytical reporting. As part of our Medical Management Team, the MCM Nurse employs best practices and principles to ensure high quality and cost-effective assurance standards.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Works onsite with a consistent schedule or attendance.
• Conducts case reviews for appropriateness/quality of treatment and bill accordingly by group concurrently.

• Tracks and reports all hours by group and patient for current Case Management patients currently in treatment

• Develops Case Management reporting and tracking of members with trigger diagnosis history currently not in treatment and develops treatment plans to save the member and group benefit dollars.

• Maintains communication between insured, medical provider, and insurance company.

• Develop strategy, goals, & objectives for each new client.

• Provides statistical case reviews and generates utilization reports

• Examine DRG pre-certification, certification of admissions, and continued stay.

• Act as a liaison between Medical and Claims departments regarding medical review issues.

• Communicate with other departments and personnel to facilitate proper adjudication of claims.

• Review medical information from various out of state facilities for medical necessity.

• Maintain medical standards for all clients.

• Communication with hospitals, physicians, and subscribers regarding certification of hospital admissions and outpatient services.

• Meets with Management team about current processes and implementing new processes

• Develops relationships with physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members.

• May access and consult with peer clinical reviewers, Medical Directors and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost effective care throughout the medical management process.

• Educates the member about plan benefits and contracted physicians, facilities and healthcare providers. Refers treatment plans/plan of care to peer clinical reviewers in accordance with established criteria/guidelines and does not issue medical necessity non-certifications.

• Maintains compliancy with regulation changes affecting utilization management.

• Reviews patients’ records and evaluates patient progress.

• Documents review information in computer. Communicates results to the appropriate parties and enters the appropriate billing information for services.

• Responds to complaints per UR guidelines.

• Records and reports all information within scope of authority

• Performs analytical reporting from a variety of reports, client charts and other documents and participates in developing strategies for medical cost containment, maintaining quality of care and client satisfaction.

The MCM Nurse will participate in the following activities either in tandem or at the direction of the department supervisor or management team:

• Actively participate with management to develop business process analyses

• Develop recommendations for appropriate solutions.

• Validate and perform quality assurance.

• Create or revise analytical approaches to reflect current priorities and circumstances.

• Develop, analyze, and implement project plans. Mobilize project teams.

• Develop plans or proposals that include cost/benefit analysis, policy, and financial, operational, and organizational implications.

• Exercise discretion, tact, and judgment when working with internal and/or external departments.

Supervisory Responsibilities: No supervisory responsibilities for this position

Knowledge, Skills, & Abilities:

• Working knowledge of ICD-10, HCPCS and CPT coding.

• Excellent communication skills, both verbally and in writing are critical.

• Knowledge of principles, practices and current trends in nursing as well as best practices in quality assurance.

• Knowledge and application of state and federal laws, statutes, and regulations; excellent analytical skills; ability to work as part of a team and be self-directed; and intermediate knowledge of Word and Excel.

• Experience in project consulting, analysis, and management.

• Communication qualifications include demonstrated verbal and written communication skills and ability to present information effectively, tailor presentations to a wide variety of audiences (including executive management), present complex concepts and recommendations clearly for management decision-making purposes.

• Ability to comprehend, interprets, and applies BRMS policies; ability to continually adjust in a dynamic environment; and ability to work as a member of a team.

• Must be able to work within core hours of operation 0700 to 1700 Monday through Friday.

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience: Graduate from accredited school of nursing with at least two years acute clinical experience with at least one year of case management or utilization review experience.

Language Skills: Ability to read, speaks, and writes effectively in English. Ability to interpret documents such as safety rules, memos, letters, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position.

Mathematical Skills: Ability to add and subtract, multiply and divide with 10's and 100's.

Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

REQUIRED Certificates, Licenses, Registrations: Current California RN or LVN License: National Medical Case Management Certification: Preferred

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. This position requires the employee to work in the office.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

Established in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs.

One of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefits

Established in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs.

One of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefits

Job Description

About Abby Care

Making family care possible. At Abby Care, we are tackling one of the most important and unsolved challenges of our time: family caregiving.

Over 50 million Americans are family caregivers for loved ones without pay, tools, or support. Our mission is clear and ambitious: to train and employ family caregivers so they can get paid for the care they already provide at home.

Abby Care is building a tech-powered, family-first care platform to efficiently deliver care, improve health outcomes, and provide the best-in-class experience nationwide.

We are rapidly expanding our mission and looking for passionate team members to join. Abby Care has partnered with leading insurance plans, healthcare providers, and community organizations. We're supported by top, mission-driven VCs to empower families throughout the country.

We're looking for a passionate and detail-oriented expert to join us as a Case Management Coordinator . This is a Full-Time Hybrid opportunity based in Denver, Colorado .

In this role, you will be the point person who makes PARs happen through Case Management Agencies. You'll proactively coordinate with county and independent case managers across numerous concurrent cases—driving clean, timely submissions, reauthorizations, and appeals—while navigating CMA workflows to keep services moving without lapses. As the expert liaison, you ensure end-to-end compliance and fast resolutions by partnering closely with CMAs and internal teams. Success means building trusted CMA relationships that ensure seamless care continuity and operational excellence in Colorado's LTHH landscape.

• Lead Case Manager Coordination. Deepen collaboration with county and independent case managers. Act as their primary point of contact for service authorizations, care plan updates, and waiver transition support to ensure seamless, coordinated care.
• Case Management Agency Relationships . Build and maintain relationships with Colorado Case Management Agencies (CMAs); proactively engage in regular meetings, case reviews, and joint resolution efforts for complex patient needs.
• Integrated Care Planning. Work alongside case managers and patients' families to co-develop care plans that align both clinical needs and Medicaid requirements, flagging potential gaps or overlaps in services related to LTHH.
• Expert Liaison. Be the "go-to" expert for both internal staff and external case managers on complex situations (e.g. multiple waivers, emergency authorizations, appeals). Ensure transparent and proactive communication at every step.
• Master Colorado's LTHH landscape. Support authorization operations for Colorado's HCBS waiver programs (CHCBS, EBD, CES, CFC) ensuring 100% compliance with HCPF policies and Colorado PAR requirements.
• Manage Reauthorizations. Build out the process and drive the team handling all collaboration with county Case Managers to submit reauthorization submissions for Colorado's waiver programs (CHCBS, EBD, SLS, CES, CFC) to ensure patients have no lapse in care.
• Drive team excellence. Create and execute training programs on Colorado-specific prior authorization requirements, mentor staff on LTHH waiver nuances, and establish performance metrics that drive strong approval rates and sub-10-day processing times.

• Superior Case Management Experience. 5+ years coordinating with Colorado case managers in Medicaid LTHH settings, with documented success facilitating seamless authorizations and care continuity.
• Leadership in Case Manager Collaboration. Expert relationship builder with strong communication, problem-solving, and stakeholder management skills; proven ability to partner effectively with case managers at both county and CMA levels.
• Existing deep knowledge of Colorado's LTHH ecosystem including HCPF policies, prior auth operations, case coordination, and ColoradoPAR system; can demonstrate successful navigation of Colorado waiver program transitions and appeals.
• Cross-functional Expertise. Demonstrated skill working with patient families, clinical teams, and multiple case managers to ensure joint problem solving and continuous coverage of care.
• Bachelor's degree in Healthcare Administration, Business, or equivalent is preferred. Colorado Medicaid certification and LTHH authorization training strongly preferred.

1. Families First
   Redefining healthcare starts with how we treat the parents and children we serve. We go above and beyond for every family, building strong, lasting relationships. We continually ask ourselves, "Would we want this for our own families?"
   
   
2. Urgency with Precision
   Millions of families are waiting for care, and they cannot wait, therefore this is not your typical 9 to 5 job. We match their urgency with our own, delivering exceptional care without compromise. Here, speed and excellence go hand in hand.
   
   
3. Relentlessly Resourceful
   As an ambitious startup, we adapt quickly and make the most of limited time and resources. We solve challenges with creativity to deliver results without unnecessary complexity.
   
   
4. Purpose with Positivity
   We take our mission seriously while never losing sight of the people behind the work. Respect, kindness, memes, and coffee make us stronger as a team and better for the families we serve.
   
   
5. Driven to Redefine What's Possible
   We are here to make healthcare better, which means asking hard questions, challenging outdated systems, and finding smarter, more compassionate ways to deliver care.

• Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work.
  • This is a Full-Time role with an estimated $55,000-$64,000 annual salary + annual bonus + benefits
• Comprehensive health coverage that works for you. We cover 90% of your premiums and 70% for your dependents, with multiple PPO plan options to choose from for medical, vision, dental, life, and short-term disability.
• Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays.
• Team bonding. We love bringing our teams together. As a full-time employee, you'll get to connect, collaborate, and have fun through team activities and our annual company retreat.
• Financial savings benefits to support your future. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k)

Job Description

About us:

Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued.

Please check out our company website at to learn more about us!

**Bilingual in English and Spanish is required**

Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match!

Our company has doubled size and we have experienced exponential growth in membership from 2,000 members to almost 7,000 members in the last year!

Join our winning Solis Team!

Position is fully onsite Monday-Friday.

Location: 9250 NW 36th St, Miami, FL 33178.

Position Summary:

Case Management Care Coordinators play a crucial role in helping members manage their health by acting as a liaison between the health plan’s Case Management Department and the member’s healthcare providers. They perform their duties as an extension of the case management team, ensuring that the components identified as part of the member’s care are addressed and arranged. The Care Coordinators provide support by reaching out to members and ensuring their needs are met. Additionally, the Care Coordinator gathers key information that enables other members of the department, as well as those in other departments, to deliver exceptional customer care through attention to detail, empathetic communication, and necessary follow-up for optimal healthcare experiences. This role requires flexibility, quick thinking, and a caring disposition.

Essential Duties and Responsibilities:

• Performs member screenings through the completion of health risk assessments.
• Completes interventions based on the member’s individualized care plan.
• Schedules appointments to support care plan goals.
• Communicates professionally with nurses and physicians, both internal and external to the organization.
• Handles inbound calls and answers member inquiries.
• Connects with members via phone and other communication methods.
• Coordinates with community resources to support interventions outlined in the member’s individualized care plan.
• Documents information accurately within the member’s electronic record.
• Assists the case management team with supporting and following up on interventions and actions.
• Ensures compliance with all regulatory requirements, including HIPAA, OSHA, and other federal, state, and local regulations.
• Assists with data collection.
• Maintains a polite and professional demeanor at all times.
• Upholds patient confidentiality at all times.
• Works effectively in a high-paced and demanding environment.
• Demonstrates the ability to multi-task and prioritize effectively.
• Assists with the training of new staff members.
• Performs other duties and projects as assigned.

Qualifications & Education:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below represent the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• High School Diploma and a minimum of two (2) years of experience in a healthcare-related customer service position, or an equivalent combination of education and experience.
• Experience in Medicare and managed care insurance is preferred.
• Knowledge of CMS guidelines is preferred.
• Excellent computer skills are required, including proficiency in Microsoft Office.
• Strong decision-making and organizational skills.
• Excellent listening, interpersonal, verbal, and written communication skills with individuals at all levels of the organization.
• Must be able to perform duties with minimal supervision.
• Willingness and ability to function independently as well as part of a team.
• Working knowledge of medical terminology.
• Fluency in both Creole and English is required.

Performance Measurements:

• Duties accomplished at the end of the day/month.
• Attendance/punctuality.
• Compliance with Company regulations.
• Safety and Security.
• Quality of work.

What set us apart:

Join Solis Health Plans as a Case Management Care Coordinator and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!

Job Description

Clinical Dietitian

Case Management

Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately dedicated to improving the health and well-being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness.

When you join the LMHS team, you become a vital part of your local community Hospital. Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors. You will be providing care in a place in which you are personally connected, where the impact of your work extends beyond the Hospital doors and into the heart of our community. Our commitment to diversity, equity, and inclusion ensures that every member of our community is served with respect and compassion. Join us in our mission – dedicated to patient safety, utilizing state-of-the-art technology, and with a passionate team of highly trained and compassionate individuals who strive to improve the health of the community.

Position Summary

Consults with Food Service regarding patient menu selection. Consults with patients, families, physicians and staff, to ensure that dietary needs are being met by making appropriate nutritional recommendations.

Responsibilities

• Ensure best practice regarding patient nutritional needs by referencing the Nutritional Care Manual.
• Completes patient nutritional assessment when ordered within required time frame. Establishes plan of care for patient's nutritional requirements.
• Counsels patients and family members regarding nutritional requirements, using appropriate instructional methods.
• Documents patient assessment and teaching.
• Calculates calorie counts, protein needs and enteral and parenteral feeding.
• Reviews progress of patients' tolerance and satisfaction with diet orders.

Requirements

• Must be a registered dietitian licensed in the state of Ohio.
• Must have knowledge of food preparation techniques and products.
• Must have strong interpersonal skills.
• Must have strong communication skills and technical skills.
• Must have ability to plan and organize.
• Open to new graduates.
• LMH is accredited by DNV and TJC, and as such, may require specific annual education related to specialty certifications and standards.

Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations. Licking Memorial Health Systems does not discriminate against applicants because of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors protected by law.

Job Description

BOYS AND GIRLS HOMES OF NORTH CAROLINA

P.O. BOX 127, 400 FLEMINGTON DRIVE

LAKE WACCAMAW, NORTH CAROLINA

POSITION/DEPARTMENT: CASE MANAGEMENT CONSULTANT

DEPARTMENT: Residential

PERSONAL QUALIFICATIONS:

Bachelor’s degree from an accredited university or college.

Two (2) years experience working with client population

Must have a complete physical with TB by a doctor prior to reporting to work. Physical health must meet all standards as established by the Department of Human Resources or other local agencies governing childcare. Medical examination shall include tests necessary to determine that the individual does not have any communicable disease or condition that poses significant risk of transmission in the facility. Must be completed on a DSS Physical Form and given to HR.

Valid North Carolina drivers license, an acceptable driving record and insurable by BGHNC carrier.

Must successfully complete all phases of pre-service and on-going training, including, but not limited to, physical restraint training, First Aid, CPR/AED, Universal Precautions, and Medication Administration.

Reasonable accommodations may be made to those who are able to perform the essential duties of the job. Background investigation required. Must provide HR with a written negative drug screening test prior to hiring.

SUPERVISOR/CHAIN OF COMMAND: Chief Residential Officer

WORKING SCHEDULE: Exempt, full-time professional, flexible schedule to meet the needs of the position and BGHNC.

GENERAL SUMMARY:

The primary responsibility of the Case Management Consultant is to provide program development and

support services to direct care staff serving youth assigned in group homes. The position’s job

responsibilities include implementing direct care services through use of the agency’s Teaching Family

Model of Care, and working with adolescents, families, volunteers, and community representatives in

the group home and community settings.

MAJOR RESPONSIBILITIES :

1. Responsible for leadership and operational management of a core team and provide development support in full implementation of the Teaching Family Model of Care.
2. Mentor, coach and supervise staff with a common goal to improve outcomes for young people in care.
3. Provide supervision, monitor workloads and individual performance.
4. Role modeling the best practice principles and your understanding of the Teaching Family Model of Care to young people and the team.

SERVICES RESPONSIBILITIES :

1. Implement direct care services according to an individualized service plan and consistent with the agency’s Teaching Family Model of Care.

2. Teach youth a curriculum of skills, including social, self-regulation, independent living and academic skills.

3. Develop, to the highest degree possible, a normalized family-style home environment providing counseling, concern, direction, assistance, and support for the youth in care. Develop and participate in creative activities for youths and staff.

4. Model appropriate moral, ethical, and professional values for youths, colleagues, and the community-at-large.

1. Regularly seek consultation from appropriate supervisory staff, provide detailed information regarding significant issues affecting youth in care, and accept and implement feedback.
2. Establish and maintain positive and effective relationships with all program consumers including but not limited to, youths, parents/family, school personnel, neighbors, referral agencies, administrators, etc.
3. Assure completionn of daily operational functions such as facility cleaning (interior and exterior) and maintenance, cooking, shopping, supplies inventory, manage financial/budget tasks, and other rotating assignments.
4. Actively monitor all aspects of the residential campus property. Work with multiple departments to ensure maintenance of all property in clean, safe, attractive manner. Comply with guidelines for property maintenance and management.
5. Drive agency vehicles for purpose of transporting youths and operating all facets of the treatment program. Transport youth for routine home activities, court appointments, medical appointments, family visits, other required appointments, and emergency situations.
6. Provide assistance and support to other program staff in their job responsibilities.
7. Work a flexible work schedule to ensure coverage of assigned homes as scheduled and on an as-needed or emergency basis.
8. Provide primary and supplemental coverage, as scheduled by administrators, for homes other than those primarily assigned, as needed.
9. Attend and take advantage of, regularly scheduled in-service and specially scheduled training sessions. Take advantage of other professional growth opportunities. Maintain required certifications and re-certifications for job by participating in available training.
10. Perform other related duties as assigned by CRO and/or CEO.

CRITICAL SKILLS/KNOWLEDGE/ABILITIES :

1. Thorough knowledge of procedures and the standards of the Teaching Family Model of Care.
2. Thorough knowledge of state and local guidelines, source materials and references relating to and operating a residential program.
3. Understands safety hazards and precautions.
4. Ability to perform physical demands associated with daily operational functions, property management, and client interactions, such as standing, bending, lifting, participation in physical activities, facility cleaning (interior and exterior) and maintenance, cooking, shopping, supplies inventory, and other rotating assignments.
5. Ability to comprehend and produce accurate program documentation, including, but not limited to, client treatment plans, progress summaries, manage financial/budget tasks and community correspondence.
6. Ability to communicate professionally with consumers, including, but not limited to, parents, colleagues, and community service providers.
7. Ability to provide on-going visual and physical proximity supervision of clients.
8. Ability to participate in recreational activities with clients, including, but not limited to, arts, athletics, and outdoor activities.
9. Ability to drive a 12 passenger van to transport clients.
10. Ability to drive for agency related events during the day or night.
11. Regular attendance at primary worksite and agency related events.
12. Ability to work a flexible schedule and shifts including overnights, weekends, holidays, and extending periods of time.
13. Position may experience verbal and/or physical aggression from client population. Must be able to work in high pressure, high stress environment.
14. Possible exposure to infectious diseases.

ORGANIZATIONAL MISSION CORE VALUES :

1. MISSION: BGHNC employees embrace the principles of integrity, servant leadership, dependability, inclusion, and commitment to promote health, healing, and hope to children, youth, and families.
2. PROFESSIONALISM: BGHNC employees demonstrate professionalism through positive leadership, giving and receiving feedback, and pursuing ongoing education and professional growth. BGHNC professionalism includes timeliness, attendance, maintaining appropriate boundaries in all settings, as well as engaging in conduct consistent with BGHNC values.
3. COMMUNICATION: BGHNC employees provide professional and empathetic feedback with all stakeholders. They communicate in a positive, strength-based approach in all interactions, demonstrating the integrity and excellence of the organization.
4. TEAMWORK: BGHNC employees engage in hands-on collaborative efforts with other team members, as well as the BGHNC organization. They strive to achieve a common goal of completing tasks in the most compassionate, effective, and efficient way – while building an extraordinary workplace with high standards. BGHNC teamwork is inclusive, equitable, and culturally competent.
5. STEWARDSHIP: BGHNC employees embrace a long-term approach to decision making. This approach benefits agency objectives while valuing clients, community, and the culture of BGHNC. BGHNC stewardship prioritizes a commitment to the organizational assets of property, staff, reputation, and history.
6. RESILIENCY: BGHNC employees demonstrate the ability to complete job responsibilities, exhibit adaptability and perseverance in all situations, maintain a growth mindset, and strive for an appropriate work/life balance.

EMPLOYEE ACKNOWLEDGMENT

This job description is a general description of the essential job functions. It is not intended as a contract of employment. Every effort has been made to identify the essential functions of this position. However, it in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position.

Job Description

Job Details:

• Title                 : Manager Case Management
• Location   : Riverside, CA 92501
• Job Type   : Full time Permanent
• Shift    : Days - Rotating Weekends - this is an exempt position so hours may vary. 
• Salary   : $142,000 to $214,000 Annually (Based on years of experience) + Full-time Benefits
• Relocation      : Case by Case

Qualifications:

• Bachelor's Degree in Nursing (BSN) required. Masters Degree (MSN) preferred.
• Current California Licensed Registered Nurse (will accept pending license)
• Minimum of 3-5 years case management in an acute hospital setting and/or nursing management experience in an acute hospital setting
• Thorough knowledge of Case Management defined by established rules and regulations of federal and non-federal programs.
• Working knowledge of both Interqual and M & R.
• Understanding of hospital reimbursement as it relates to different payers such as Medicare, Medi-cal, Managed Care and private insurance plans.

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

Job Description

Job Description: 
Position: RN-Case Manager
Duration: 13 weeks
Shift: M-F, 40hr days, 8hr/day, Occasional weekend & Holidays

Requirements:
BSN required
Active MA state RN license required
3+ yr of Hospital Case management & Utilization review required
BLS (AHA)
Covid Card

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

• Department:  Case Management
• Schedule:  Full Time, Day Shift
• Hospital:  St. Elizabeth
• Location:  Appleton, WI

Paid time off (PTO)
Various health insurance options & wellness plans
Retirement benefits including employer match plans
Long-term & short-term disability
Employee assistance programs (EAP)
Parental leave & adoption assistance
Tuition reimbursement
Ways to give back to your community

Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer.

Coordinate the overall interdisciplinary plan of care for patient, from admission to discharge.

• Create plan for care across the continuum, integrating patient/family preferences and values.
• Monitor patient medical necessity and level of care through assessments, ongoing evaluations and/or patient records.
• Advocate for resources and removal of barriers.
• Maintain ongoing dialog with supervisor and care transition team members to ensure effective implementation and reevaluation of health plan.
• Act as a resource for adequate medical record documentation, level of care  recommendations, and services as they relate to diagnoses, and treatment options for post-discharge care.

Licensure / Certification / Registration:

• Registered Nurse credentialed from the Wisconsin Board of Nursing obtained prior to hire date or job