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The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
$135,150 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Hours: Monday - Friday 8:30am to 5:00pm EST The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
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We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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Job Description :Manager, Provider Network Management LTSSLocation: KansasHours: M – F Standard Working hoursTravel: Hybrid (1-2 days onsite) 20% Travel with potential overnight as neededPosition Overview:Directs the activities related to the development and maintenance of the company's Long Term Services and Supports (LTSS) provider delivery system through the provider relations representatives.
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Job Description :Medical DirectorAt Federal Health Products and Services - FHPS, a proud member of the Elevance Health, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities.
$342,936 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs.
$101,088 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
$150,912 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Preferred Skills, Capabilities and Experiences: Experience working in the managed care/healthcare insurance industry most notably in pharmacy benefits; PBM experience strongly preferred. Provides both on-site and off-site account management, which may include interpreting plan design, researching and resolving phone and written inquiries, resolving claims, benefit and enrollment issues.
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Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process. Experience in conducting prior authorization reviews for DMEs, home health services, pain management, elective inpatient services, or prosthetics/orthotics.
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The LTSS Service Coordinator- RN is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case, as required by the Texas Medicaid STAR+ PLUS program; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum.
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Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Assists with development of utilization/care management policies and procedures.
$113,526 a yearFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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The Managed Care Coordinator – RN Clinician is responsible for overall management of member’s case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member’s case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member’s care plan to meet the member’s needs, with the goal of optimizing member health care across the care continuum.
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