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Case Manager
2 weeks ago
Bright Beginnings ESCNEO Independence, United States Full timeJob Description · Job DescriptionSalary: Salary ranges from $ 34,000 - $47,600 · Bright Beginnings provides services in Cuyahoga County and across the State of Ohio that support families in helping their children grow, learn, and develop to their fullest potential. Last year Brig ...
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Case Manager
2 weeks ago
Bright Beginnings ESCNEO Independence, United States Full timeJob Description · Job DescriptionSalary: Salary ranges from $ 35,700 to $49,980 pending experience level. · Bright Beginnings provides services in Cuyahoga County and across the State of Ohio that support families in helping their children grow, learn, and develop to their fulles ...
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Case Manager
2 weeks ago
Bright Beginnings ESCNEO Independence, United States Full timeJob Description · Job DescriptionSalary: Salary ranges from $ 35,700 - $49,980 pending experience level. · Bright Beginnings provides services in Cuyahoga County and across the State of Ohio that support families in helping their children grow, learn, and develop to their fullest ...
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RN Case Manager
17 hours ago
Visiting Nurse Association of Ohio Brooklyn Heights, United States Full timeOverview: · Sign On Bonus: $5,000 · Come Join a Dynamic Team · The VNA of Ohio is currently seeking a full time RN Case Manager for West Cuyahoga territory · The RN Case Manager will be responsible for providing direct or indirect skilled comprehensive nursing care to a specified ...
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RN Case Manager
17 hours ago
Visiting Nurse Association of Ohio Brooklyn Heights, United States Full timeOverview: · Sign On Bonus: $5,000 · Come Join a Dynamic Team · The VNA of Ohio is currently seeking a Full-Time RN Case Manager for West Cuyahoga territory · The RN Case Manager will be responsible for providing direct or indirect skilled comprehensive nursing care to a specified ...
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RN Case Manager
17 hours ago
Visiting Nurse Association of Ohio Brooklyn Heights, United States Full timeOverview: · Sign On Bonus: $5,000 · Come Join a Dynamic Team · The VNA of Ohio is currently seeking a full time RN Case Manager for East Cuyahoga territory · The RN Case Manager will be responsible for providing direct or indirect skilled comprehensive nursing care to a specified ...
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RN Case Manager
1 day ago
Sanctuary Hospice Independence, United StatesOverview · Our Sanctuary Hospice team is looking for a Full-Time Registered Nurse Case Manager (RNCM) that is ready to make a meaningful difference in the lives of the patients and families we serve in and around Geuga and Lake Counties · We are looking for a high-energy, compa ...
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RN Case Manager
4 days ago
Visiting Nurse Association of Ohio Independence, United StatesOverview: · Below, you will find a complete breakdown of everything required of potential candidates, as well as how to apply Good luck. · Sign On Bonus: $5,000 · Come Join a Dynamic Team · The VNA of Ohio is currently seeking a Full-Time RN Case Manager for West Cuyahoga territo ...
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RN Hospice Case Manager
5 days ago
Visiting Nurse Association of Ohio Independence, United States PermanentOverview: · Sign On Bonus: $5,000 · Come Join a Dynamic Team · At Visiting Nurse Association of Ohio, we are looking for dependable, compassionate people interested in gaining experience and becoming an invaluable resource to our organization. VNA of Ohio is now hiring a Hosp ...
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RN Case Manager
2 days ago
Visiting Nurse Association of Ohio Brooklyn Heights, OH, United States Full timeOverview: Sign On Bonus: $5,000 Come Join a Dynamic Team The VNA of Ohio is currently seeking a full time RN Case Manager for East Cuyahoga territory The RN Case Manager will be responsible for providing direct or indirect skilled comprehensive nursing care to a specified (or va ...
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RN Case Manager Behavioral Health
17 hours ago
Visiting Nurse Association of Ohio Brooklyn Heights, United States Full timeOverview: · Come Join a Dynamic Team · At Visiting Nurse Association of Ohio, we are looking for dependable, compassionate people interested in gaining experience and becoming an invaluable resource to our organization. VNA of Ohio is now hiring a Full-Time RN Case Manager Mental ...
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RN Case Manager Hospice
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Caretenders Hospice Cleveland, United StatesWe are hiring for a Registered Nurse Case Manager in Hospice. · Interviewing for Full Time, Part Time or PRN · At Caretenders Hospice, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole ...
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RN Case Manager
2 weeks ago
Visiting Nurse Association of Ohio Brooklyn Heights, OH, United StatesOverview · Sign On Bonus: $5,000 · Come Join a Dynamic Team · The VNA of Ohio is currently seeking a full time RN Case Manager for East Cuyahoga territory · The RN Case Manager will be responsible for providing direct or indirect skilled comprehensive nursing care to a specified ...
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RN Case Manager
4 days ago
Visiting Nurse Association of Ohio Independence, United StatesOverview: · Are you the right candidate for this opportunity Make sure to read the full description below. · Sign On Bonus: $5,000 · Come Join a Dynamic Team · The VNA of Ohio is currently seeking a full time RN Case Manager for West Cuyahoga territory · The RN Case Manager will ...
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RN Case Manager
4 days ago
Visiting Nurse Association of Ohio Independence, United StatesOverview: · Find out more about this role by reading the information below, then apply to be considered. · Sign On Bonus: $5,000 · Come Join a Dynamic Team · The VNA of Ohio is currently seeking a full time RN Case Manager for East Cuyahoga territory · The RN Case Manager will be ...
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RN Case Manager
4 days ago
Visiting Nurse Association of Ohio Independence, OH, United States Full timeOverview: Find out more about this role by reading the information below, then apply to be considered. Sign On Bonus: $5,000 Come Join a Dynamic Team The VNA of Ohio is currently seeking a full time RN Case Manager for East Cuyahoga territory The RN Case Manager will be responsi ...
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RN Case Manager
4 days ago
Visiting Nurse Association of Ohio Independence, OH, United States Full timeOverview: Below, you will find a complete breakdown of everything required of potential candidates, as well as how to apply Good luck. Sign On Bonus: $5,000 Come Join a Dynamic Team The VNA of Ohio is currently seeking a Full-Time RN Case Manager for West Cuyahoga territory The ...
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RN Case Manager
4 days ago
Visiting Nurse Association of Ohio Independence, OH, United States Full timeOverview: Are you the right candidate for this opportunity Make sure to read the full description below. Sign On Bonus: $5,000 Come Join a Dynamic Team The VNA of Ohio is currently seeking a full time RN Case Manager for West Cuyahoga territory The RN Case Manager will be respon ...
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Case Manager
3 days ago
Signature Health Maple Heights, United StatesQualified Mental Health Specialist (QMHS) · Are you looking for an organization where you can grow while making a positive impact on people's lives? At Signature Health, our purpose is to provide integrated healthcare for our community specializing in patients with mental illness ...
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RN Medical Case Manager
1 day ago
Visiting Nurse Association of Ohio Brooklyn Heights, OH, United States Full timeOverview: · Sign On Bonus: $5,000 · Come Join a Dynamic Team · At Visiting Nurse Association of Ohio, we are looking for dependable, compassionate people interested in gaining experience and becoming an invaluable resource to our organization. VNA of Ohio is now hiring a Hospic ...
Employee Health Plan Case Manager - Independence, United States - Cleveland Clinic
Description
Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation.At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.
The ideal future caregiver is someone who:
Has previous experience with medical insurance, claims and customer service. Independently problem solves and recognizes non-routine situations that should be brought to the attention of the supervisor/manager. Communicates in a professional manner, both verbally and written. Is proactive when observing possible barriers to the efficient and timely completion of department processes, workflows and tasks.
Within your first year of eligibility, you will be supported in becoming a Certified Case Manager.
At Cleveland Clinic, we know what matters most.
That's why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you.
Here, you'll find that we offer:
resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future.
When you join Cleveland Clinic, you'll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.
Job Responsibilities:
Recommends resource utilization.
Prioritizes and organizes work to meet changing priorities.
Utilized analytical ability required to gather data. Uses clinical judgment to apply predetermined criteria.
Applies medical necessity guidelines accurately to monitor appropriateness of items requiring prior authorization.
Follows department guidelines on escalation processes to management and refers cases appropriately to the Medical Director.
Maintains and supports collaborative relationships with multidisciplinary team members such as Customer Management Specialists, Pharmacy, Care Coordinators, Medical Directors, etc.
Documents appropriately in Tapestry to provide evidence that the UR process for the referral was followed.Monitors in-network and out of network utilization of providers and services.
Monitors for potential high dollar costs and redirects when appropriate.
Coordinates transfer of care to in-network facilities for patients admitted to out-of-network facilities.
Contacts recently discharged members via telephone per department protocol and interacts with all callers in a professional and courteous manner and follows established guidelines and document all interactions via EMR and department systems accurately.
Serves as a liaison between health plan, patient and providers as needed.Other duties as assigned.
Education:
Graduate from accredited school of Nursing with licensure as a Registered Nurse (RN).Bachelor of Science in Nursing preferred.
Certifications:
Current state licensure as a Registered Nurse (RN).RN requires additional Multistate License (MSL) or eligible for MSL to be obtained within 90 days of hire.
Basic Life Support (BLS) through American Heart Association (AHA).
Competencies:
Knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures, and basic disease processes.
Analytical ability required to gather data, decide on conformity based on predetermined criteria, and identify problems and ref for resolution.
Basic knowledge of medical records coding standards.Awareness of licensing and accreditation standards.
Proficient with Microsoft Office.
Knowledge of billing practices, identification of billing problems, adequacy of documentation, and ability to conduct research of issue at hand, as well as formulate recommendations based on findings preferred.
Knowledge and experience with Care Guidelines, Medical Necessity Criteria and/or other Utilization management criteria sets.Must possess advanced interpersonal and communication written and verbal skills necessary to gather and exchange data (both internally and externally) with members of the health care team.
Expertise with electronic medical records preferred.Ability to work self-directed with minimal supervision in a work from home environment.
Work Experience:
Three years relevant clinical experience required. May prefer specific clinical setting depending on area of assignment.
One year of experience in a managed care setting, previous work with network providers, care coordination, case management or utilization management preferred.
Physical Requirements:
Manual dexterity to operate office equipment.
May require extended periods of sitting.
Good visual acuity through normal or corrected vision and good audio acuity.
Personal Protective Equipment:
Follows standard precautions using personal protective equipment as required.
Salaries [which may be] shown on independent job search websites reflect various market averages and do not represent information obtained directly from The Cleveland Clinic.
Because we value each individual candidate, we invite and encourage each candidate to discuss salary/hourly specifics during the application and hiring process.
