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Occ SummaryIn conjunction with the Health System Director, this position provides daily operational oversight, management and leadership for staff of the Case Management Department whose activities are associated with the continuum of care, clinical cost reduction, utilization management, care transitions, population management, clinical social work, quality, performance improvement, reimbursement and discharge planning.
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Join our post-acute care Inpatient Rehab Facility with excellent retention. Support from Hospitalists, RN Case Management, Social Work, Psychology, and alternative medicine.
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Minimum 3-5+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
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Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation.
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Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. The Behavioral Health Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management.
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Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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Experience with Managed Care, Utilization Management, Prior Auth, and Benefits Management decision support in the Post-Acute Domain, DME, Home Health, and Wound Care. Experience leading teams directly or leading teams in a matrixed environment.
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5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare or Medicaid type population.
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Carelon Medical Benefits Management is looking to hire a National Medical Director Post Acute Care Solutions. This high-performing individual contributor will be responsible for serving as a National Medical Director for our Post Acute Solutions Clinical Product Line, overseeing clinical integrity for the service line, supporting the product strategy and design, and implementing medical management approaches that impact healthcare quality, cost, and outcomes.
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Experience with Managed Care, Utilization Management, Prior Auth, and Benefits Management decision support in the Post-Acute Domain, DME, Home Health, and Wound Care.
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Realize the positive, personal impact of leadership on a greater scale with national post-acute care leader Encompass Health. Preferred: Two years of senior management experience in health care, including: Hospital (or comparable corporate, region, or subsidiary) responsibility for one or more of the following departments: Finance & Accounting, Marketing, Nursing, Therapy (inpatient), Quality, Case Management, or Human Resources.
$125,000 - $140,000 a yearExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Provides clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of Clients in cooperation with solution medical directors and the Chief Medical Officer.
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Job Summary: The Transitional Care Nurse (Clinical Liaison) is an integral member of the CVS Care Transitions Team. The Transitional Care Nurse (RN) will work closely with patients, health care providers and partners to facilitate timely post discharge support for patients transitioning from an acute care setting to home.
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Preferred QualificationsKnowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age.
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post acute care case management jobs
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