14147 rn case manager jobs found

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Case Manager/Care Coordinator II is responsible for the coordination of services and cost effective management of health care resources to meet individual members’ health care needs and promote positive health outcomes. Acts as a member advocate and a liaison between providers, members and HN to seamlessly integrate complex services. Case Management services are generally focused on members who fall into one or more high risk or high cost groups and require significant clinical judgment, independent analysis, critical-thinking, detailed knowledge of departmental procedures, clinical guidelines, community resources, contracting and community standards of care. Case Management...

Summary Utilizing a collaborative process with the Complex Care Coordination (CACO) Social Worker, the RN Case Manager will assess, develop, and implement a plan of care to meet the individual health care needs of children with complex medical problems or special health care needs, who have multiple specialists and who are at risk for frequent healthcare utilization Using effective communication skills and available resources, the RN Case Manager will provide support and reinforce education across multiple service delivery settings in an effort to meet patients’ unique needs and access care for quality, cost-effective outcomes. The RN Case Manager in conjunction with the CACO Social Worker: • Maintains an onsite presence to do timely real time reviews of patient referrals. Exceptions to this expectation will require Director approval. • Assists in coordinating effective use of hospital and community resources, • Facilitates communications among patient, physicians, family, and...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Pediatric case management for highly medically complex members (ages 0-21 years). Florida RN license needed. Work-from-home role with home visits in Broward County (Fort Lauderdale, Sunrise, Lauderhill, Pompano Beach, FL area). Must reside in the above mentioned area of Florida.  Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care • Develop, assess and adjust, as necessary, the care plan and promote desired outcome • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis,...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. This is a pediatric case management role for our 0-21 year old members. Florida RN license needed for role. Work-from-home role with home visits in southern Palm Beach County (Boca Raton, Delray Beach, Boynton Beach, FL area). Strong preference for the individuals that reside in the southern Palm Beach County, FL. Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care • Develop, assess and adjust, as necessary, the care plan and promote desired outcome • Assess the member's current health status, resource utilization, past and present...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Pediatric administrative case management roles for registered nurses (RN). Serving our members ages (0-21 years). Work-from-home role with home visits in the north/central Palm Beach County (Palm Beach Gardens, Belle Glade, Tequesta, Pahokee, Riviera Beach, West Palm Beach, FL). Must reside in the county mentioned area of Florida, but preference for applicants that reside in the northern half of the county. Position Purpose:  Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care • Develop, assess and adjust, as necessary, the care plan and promote desired...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Pediatric case management for members (ages 0-21 years). Florida RN license needed. Work-from-home role with home visits in Broward County (Fort Lauderdale, Sunrise, Lauderhill, Pompano Beach, FL area). Must reside in the above mentioned area of Florida.  Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care • Develop, assess and adjust, as necessary, the care plan and promote desired outcome • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term...

Summary The Manager, RN Case Managers is responsible for the management of the RN Case Manager staff to ensure efficient delivery of Case Management services. Functions as a resource to the Case Management staff and assists the RN Case Managers with issues affecting patient care management. Provides consultation services to all Case Management staff related to payor benefit, authorization and appeal processes. Assists the department Director in overseeing the operations of the Case Management department. Education & Experience BSN required, Masters in Nursing preferred. Five years clinical experience. Minimum 3 years experience in case management/utilization review required, preferably in a pediatric environment. Minimum 1 year demonstrated management experience preferred. Ideal candidate is knowledgeable and/or experienced with managed care systems. Computer literate. This position requires organizational and interpersonal skills. Excellent oral...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Location: San Antonio, TX Hybrid position – Work from home and conduct assessments via field visits. Pediatric RN Case Manager to assess and manage child and adolescent members with complex medical conditions As a Care Manager RN - Pediatrics, you will: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. • Meet with families and pediatric members in person to assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment and provider options • Utilize...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Location: Austin, TX STAR Kids is seeking Pediatric RN Case Manager to assess and manage child and adolescent members with complex medical conditions Hybrid position – Work from home and conduct assessments via field visits As a Care Manager RN - Pediatrics, you will: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options • Utilize assessment skills and discretionary judgment...

Summary The RN Case Manager uses a collaborative process to plan, assess, implement, monitor and evaluate the options and services required to meet the healthcare needs of patients using the functions of Utilization Review using InterQual and Milliman Care Guidelines, Discharge Planning and Case Management in order to facilitate: (1) quality of patient care; (2) cost effective utilization and outcome management; (3) communication between patients, families, and members of the health care team; (4) expedition of the movement of patients through appropriate levels of care; and (5) information gathering for Quality & Risk Management utilizing Joint Commission Accreditation of Healthcare standards and clinical indicators. The Case Manager will assist with the identification of appropriate providers and facilities throughout the continuum of care, to ensure that resources of both CCMC and the patient are used in a timely and cost-effective manner to meet the healthcare needs of...

Summary Title:Case Manager/Service Coordinator RN Performs case management/service coordination activities that enable Cook Children’s Health Plan members with chronic conditions or complex needs to achieve an optimal level of health and independence through advocacy, assessment, planning, communication, education, resource management, care coordination, collaboration, and service facilitation. This is an office-based position with required field work. Driving and in home visits are required up to 75% of the time. Some weekends may be required to meet member needs. Education & Experience: Requires a Nursing Diploma or Associates Degree in nursing. Bachelor of Science in nursing strongly preferred. Three years of clinical experience. Two (2) years of experience working with vulnerable populations and people with chronic or complex conditions preferred. Strong skills in medical assessment/medical record review and/or behavioral health assessment....

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. These positions provide Case/Care Management for Military Families. They require RN licensure as well as Certification as a Case/Care Manager. Adult and Pediatric OR NICU experience preferred. Position Purpose: Provides Case Management services to a specific clientele. Systematically identify and addresses fragmentation of care, and fill gaps in are using proactive initiatives. Assesses medical records for appropriateness, level of care provided and criteria determination. Identifies appropriate care for patients by evaluating high-risk cases, intensity and complexity of services, health care costs and non-compliance issues. Coordinates care between multiple providers. Develops care plans in...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. This position requires you to reside in San Benito or Harlingen. This is a hybrid role. Care Manager's spend 2-3 days a week in the field visiting members to do assessments; the other days are fully remote from home. Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. . Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting....

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Pediatric case management for members (ages 0-21 years). Florida RN license needed. Work-from-home role with home visits in Broward County (Fort Lauderdale, Sunrise, Lauderhill, Pompano Beach, FL area). Must reside in the above mentioned area of Florida. Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals,...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options • Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes • Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Opportunities in Lubbock and Amarillo TX This is a hybrid position. Field visits and work remotely from home Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options • Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. This is a work-from-home role with minimal travel required. Preferred candidate must reside in Florida. Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. If you are an experienced Registered Nurse (TX-licensed RN), Superior Health Plan has career opportunities for you to transition into RN Case Management, Service Coordination, Utilization Management and more. Work from home or hybrid positions throughout TEXAS. As a Care Manager RN, you will: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options • Utilize assessment skills and...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options • Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes • Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options • Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes • Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and...