Find clinical, allied health, care team, and healthcare operations openings using one smart search field across cities, regions, and employers.
Humana
Overview
Conduct comprehensive clinical reviews of prior authorization requests for behavioral health services to determine medical necessity and benefit eligibility. Coordinate with healthcare providers and medical directors while documenting findings in clinical systems to ensure regulatory compliance.
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Compensation
Salary not listed
Posted
14 days ago
Duke Careers
The Population Health Care Manager provides clinical expertise for complex patient populations, performing disease management, care plan development, and facilitating referrals to meet contractual requirements. This role functions as an integral part of an interdisciplinary team to achieve optimal clinical outcomes, focusing on improving health status for individuals with complex medical and psychosocial issues.
15 days ago
CVS Health
The RN Case Manager leads care management activities in partnership with the primary care provider, focusing on complex patients to prevent avoidable admissions and drive efficient resource utilization. Responsibilities include managing an assigned caseload, owning overall care coordination, managing transitions of care episodes, and leading in-person interdisciplinary care planning meetings.
$72,627 - $155,538 / YEAR
17 days ago
Providence
Provide professional, patient-centric care management services for at-risk patients in an acute care environment. Responsibilities include assessment, discharge planning, and identifying resources to overcome social, financial, or legal barriers to care.
$33 - $58 / HOUR
28 days ago
AtlantiCare Rehabilitation Hospital
The Case Manager coordinates healthcare decisions and treatment plans to improve patient outcomes and ensure cost-effective care. They are responsible for assessing psychosocial needs and implementing safe discharge plans across the continuum of care.
$45 / HOUR
1 month ago
Erickson Senior Living
The Care Coordinator facilitates efficient care for targeted health plan members by identifying high-risk individuals, assessing their medical circumstances, and coordinating necessary interventions with various providers to ensure the highest level of independence possible. This role involves developing customized care plans, monitoring compliance, reassessing effectiveness, and maintaining comprehensive computerized medical and social histories for assigned patients.
$85,000 / YEAR
UF Health
The Case Manager uses professional nursing skills to assess patient scenarios and establish plans for the effective management of the continuum of care. Key goals include proactive, individualized planning to optimize quality of care, cost, and patient satisfaction.
RADcube - A NLogix Company
Coordinate patient care and transitions in collaboration with multidisciplinary clinical teams to ensure appropriate resource utilization. Perform clinical assessments, discharge planning, and collaborate with third-party payers for service coverage.
Highmark Health
The Case Manager is responsible for creating, implementing, and evaluating patient care plans while collaborating with interdisciplinary teams to optimize outcomes. They also manage readmissions, length of stay, and ED utilization while advocating for the needs of patients and their families.
St. Joseph's Health
The Utilization Management RN evaluates the medical necessity and appropriateness of healthcare services to ensure efficient patient care delivery. They are responsible for obtaining payer authorizations and maintaining documentation to minimize the risk of claim denials.
$49 - $74 / HOUR
UnitedHealth Group
The RN Clinical Care Coordinator manages a panel of members with complex medical and behavioral needs by conducting comprehensive assessments and implementing person-centered care plans. They provide ongoing education, coaching, and advocacy while coordinating care transitions and collaborating with internal teams and community resources.
$40 - $54 / HOUR
Beth Israel Lahey Health
The Case Management RN identifies continuing care needs and collaborates with patients, families, and community services to establish coordinated discharge plans. They also conduct ongoing assessments to determine the necessity of acute care and optimize reimbursement through collaboration with the utilization review team.
$37 - $82 / HOUR
Select Medical Rehabilitation - Palm Beach
The Case Manager coordinates healthcare decisions and treatment plans to improve patient outcomes and quality of care. They are responsible for managing utilization, fiscal oversight, and implementing safe discharge plans for patients.
Hennepin Healthcare
The Utilization Review Registered Nurse evaluates the medical necessity, appropriateness, and efficiency of healthcare services using established criteria like InterQual. This role collaborates with clinical teams, payers, and patients to optimize resource utilization and ensure quality care progression.
2 months ago
Community Care of North Carolina Inc
The Care Manager will provide integrated, whole-person care management by assessing, planning, and coordinating services for Medicaid-enrolled members receiving adoption assistance. They will collaborate with multidisciplinary teams, primary care providers, and families to ensure seamless access to health resources and support optimal health outcomes.
The RN Clinical Care Coordinator acts as the primary care manager for members with complex medical and behavioral needs, conducting comprehensive assessments and developing person-centered care plans. They spend 80% of their time in the field to provide coaching, coordinate care transitions, and advocate for members' health and socioeconomic needs.
Select Medical Rehabilitation - Madison
The Case Manager coordinates healthcare decisions and treatment plans to improve patient outcomes and quality of care. They are responsible for managing discharge planning, fiscal oversight, and ensuring compliance with utilization management criteria.
The Field Care Coordinator facilitates, promotes, and advocates for enrollees’ ongoing self-sufficiency by conducting comprehensive needs assessments and developing person-centered care plans in collaboration with the Interdisciplinary Team. This role involves extensive travel to conduct in-depth assessments, coordinate care delivery, manage transitions, and act as a liaison between the Health Plan, Commonwealth, enrollees, and families.
$24 - $43 / HOUR
Sanford Health
The role involves providing expertise and leadership for effective resource management in patient care delivery across the care continuum, collaborating with licensed practitioners to coordinate care and facilitate discharge needs. Responsibilities include enhancing clinical outcomes and patient satisfaction while managing care costs through evidenced-based practice and efficient utilization of health services.
$37 - $51 / HOUR
CorVel Corporation
The role involves providing in-person and telephonic Medical Case Management to injured workers, collaborating with patients, providers, and employers to facilitate recovery. Responsibilities include assessing treatment plans for appropriateness and necessity, attending provider visits, and coordinating necessary care like durable medical equipment.
$63,739 - $95,264 / YEAR
