Identifies and submits modifications, requests for exceptions or special programs. 26 idd care manager jobs available in Pittsburgh, PA. See salaries, compare reviews, easily apply, and get hired. 2.2. Maintain a safe facility and use safety first practices to remain accident free, One (1) year of clinical experience in post-acute care setting preferred, Prior case management, utilization review, and discharge planning experience preferred, Certified Case Manager (CCM) or Board Certification in Nursing Case Management (RN-BC) preferred, Must implement the standards of practice for care management, ethical performance, and functions relevant to coordination of care, Must be able to read, write, speak, and understand the English language, Support the development and implementation of care management activities for high risk patients such as those who are not meeting desired clinical outcomes, who have frequent hospitalizations or ER visits, and those with uncontrolled multiple chronic conditions in the ambulatory setting, Develop comprehensive care plans and document progress and interventions in the Electronic Health Record (EHR), Develop and implement a patient risk stratification model that aims to identify patients with chronic disease who are at risk and may require focused care management support to achieve the patients’ optimal health goals, Collaborate with Data Analyst to create, use, and maintain a care management reporting structure that identifies patients who are likely to benefit from care management services and is able to track the progress of eligible patients who are receiving care management services, Targeted clinical assessments, medication reconciliation, psychosocial and self-management assessment and support, multi-disciplinary care planning, identification of relevant social determinants of health, and ongoing treatment plan adjustment and evaluation, Overseeing coordination of residents’ health and wellness needs, Have a current state license as a Practical Nurse/Vocational Nurse, Provides discharge/transition assessments, Participates in system-wide development of clinical best practice pathways, Provides patient education materials, order sets, and implements successfully, Conduct pre-residency assessments and screening of potential residents and make recommendations for appropriate level of residency in conjunction with the Admissions Committee and other team members, Evaluate the psychosocial and activity of daily living (ADL) needs of residents in Memory Care and coordinating care and services as needed, Monitor the successful engagement of activities for residents with cognitive impairment throughout the Continuum of Care, Lead a holistic, Person-Centered approach to assessment and service/care planning, Work with interdisciplinary team to communicate with residents and families before plan of care is changed (when possible) or when there is a change in the resident’s condition, Partner with Assisted Living Manager to develop support groups and educational programming opportunities for residents and family members in the Memory Care neighborhood and partner with Independent Living and Post-Acute Social Workers to effectively support Residents transitioning between levels of care, Educates residents about the importance of Advance Directives and facilitates completion of such documents, Maintains a working knowledge and ensures compliance of Federal, State, and local regulations, as well as facility policies regarding Memory Care (and level of care – LTC or ALF), Social Work degree or degree in related field is required, Greater than 5 years related experience in providing services for residents with cognitive impairment and or managing/leading a Memory Care neighborhood required, Demonstration of progressive approaches to supporting and enhancing the quality of life for seniors with cognitive impairment, Must demonstrate knowledge of geriatric population and the aging process; including the physical, psychological and social needs of the elderly, Coordinates the clinical care with the patient, family, physician(s), and other members of the interdisciplinary team, Completes and documents admission, concurrent, and discharge reviews of all inpatients and selected outpatients, Develops and implements an effective discharge plan while incorporating input from the patient, family, physician(s), and other members of the interdisciplinary team, Identifies, analyzes, collects, and communicates data relative to quality and cost issues related to the assigned patient population, Expands industry knowledge base for professional growth and development while providing ongoing applicable education to the patient, family, physician(s), and other members of the interdisciplinary team (IDT) including, but not limited to, appropriateness of care, documentation requirements, severity of illness and intensity of services criteria, insurance benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues, Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies, Performs a comprehensive assessment on a targeted patient population as defined by MGH/MGHPO and contractual constituents, Identifies key barriers to care and patient’s ability to manage their health and wellness through initial and on-going assessments, Develops and ensures the implementation of a comprehensive plan of care in conjunction with the patient’s PCP, appropriately utilizing the menu of services for patients, as well as, insurance approved, community and practice-based and MGH services, Ensures that all elements critical to the plan and trajectory of care have been communicated to the patient/family and members of the Interdisciplinary Team, Communicates and collaborates with care teams during the various points of transition of care and monitors patients in non-acute facilities in collaboration with the iCMP Care Team, Attends patient/family Team meetings as appropriate, Identifies patients/families with complex psychosocial and non-medical discharge planning issues and refers to and collaborates with other iCMP team, members as appropriate, In collaboration with iCMP team, monitors the patient’s progress and plan of care with the aid of internal and external utilization and quality guidelines. Duties and Responsibilities. Suggests medical alternatives that accomplish treatment plan goals. This includes understanding and engaging in key local and national, health care issues/strategies, customer issues/trends and best practices to establish credibility beyond product and therapeutic areas, Take an active leadership role with NICMs to ensure the development and pull through of Strategic Account plans consistent with achieving regional and corporate goals, Cultivate effective relationships with Key C-Suite and administrative roles within an account (CEO, CFO, CMO, Pharmacy Director, Medical Director, Case Management, Dir. Ensures clinical information in the medical record and/or care management software is clear, complete, and reflects the patient’s true severity of illness by interacting with providers and staff to improve the overall quality of the clinical documentation, Regulations. An equivalent combination of education and/or experience may be considered, Knowledge of admission and continued stay criteria, Knowledge and skills necessary to evaluate appropriate care for patients from neonates to geriatrics, Knowledge of federal, state and managed care rules and regulations including CMS and AHCCCS, Excellent interpersonal skills and the ability to effectively communicate verbally and in writing providing excellent customer service, Computer literacy and proficiency in Microsoft Windows, Basic proficiency with MS Office (Outlook, Word, Excel, PowerPoint, Publisher), Demonstrates excellent clinical, written and oral communication skills, Demonstrates knowledge of clinical treatment, case management and community resources, Develops specific outreach plans for assigned members who do not maintain regular contact with their behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care, Identifies provider issues and recommendations for improvement, Independently problem solves based on advanced-level knowledge of the service delivery system, the provider network, member services policies, members' rights and responsibilities, and the operating practices of the organization, Maintains contact with and refers members to community based case management services as appropriate, Participates in CQI activities and provider training, Responds to member and provider complaints according to Community Care's policies and procedures, Works with members and providers to customize services to best meet members' needs within the scope of Community Care's obligations to its members, Experience in managed care strongly preferred, Certification in substance use disorders helpful, Supervisory or other leadership experience in behavioral health also preferred, Checks for medication updates with Resident Care Director (RCD) or Wellness Nurse, Partners with community team to ensure community is in compliance with OSHA requirements and promotion of Risk Management programs and policies; adherences to safety rules and regulations, Reports all unsafe and hazardous conditions/equipment immediately, Utilizes the Sunrise Problem Resolution system, Minimum of one (1) year experience working with seniors in assisted living, home health, independent living, hospital or long term care environment and desire to serve and care for seniors, Medication Management Certified with a successful completion of Sunrise University mediation management training, Ability to make choices, decisions and act in the resident's best interest, Assesses for appropriateness of level of care setting from admission through discharge, Identifies patients requiring care management and takes the lead as care manager for those requiring intervention, especially with clinically complex cases, Conduct on-site review of medical records at clinical facilities according to organization standards, Maintain frequent telephone contact with clinical service providers to perform defined duties and facilitate communication between the organization and the provider, Document UR/case management activities such as precertifications, concurrent and retrospective reviews, Consult regularly with other organization staff to review treatment plans when level of clinical care requires further clarification, Maintain a tracking system and clear, concise records for monitoring and reviewing cases, Prepare documentation/case synopsis upon closure of cases as required by clients, Provide phone crisis intervention services and precertification evaluations for inpatient hospitalization and other levels of care, Provide consultation and training to providers regarding authorization procedures and utilization review for a specific course or nature of treatment, Contribute to policy review and procedure development and evaluation, Performs other duties as assigned, some of which may be essential to the job, BSN required within 5 years of employment, Minimum of 3 years of clinical nursing experience, required, Knowledge and experience with managed care, required, Requires a BS/BA degree; Financial, Business, and Leadership acumen; at least 5 years relevant experience in Health Care; or any combination of education and experience, which would provide an equivalent background, MBA, MHA, MA preferred. Sensitive to cultural diversity and low literacy issues in care provision, Assist member with transition of care between health care facilities including sharing of clinical information and the plan of care, Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member. The majority of the Clinical Care Managers work is done telephonically, Partner with the licensed nursing staff to plan, develop, organize, provide and execute individualized restorative therapy programs, Works with the chair of the department and the Director of Care Management to develop standards and education around medical necessity, Knowledgeable of Community Resources and Alternate Care facilities, Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload, Intermediate Ability to create, review and interpret treatment plans Ability to create, review and interpret treatment plans, Ability to troubleshoot or explain basic hardware and software errors and work with a Technician by remotely to perform step-by-step repairs, Excellent Interpersonal skills and ability to work effectively and independently, Able to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines, Detail oriented with strong organizational, planning, and problem solving skills, Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner, 3+ years of clinical experience with a focus in managed care, including disease or case management, Able to understand and apply coverage guidelines and benefit limitations, Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses (depression, challenging behaviors, Alzheimer’s disease and other disease-related dementias) in an ethnically diverse, dual-eligible aging population, Comfortable with conducting home visits and commuting within the service area, Basic computer skills and demonstrates a willingness to learn more advanced skills, MLTC experience, including appropriate support services in the community and accessing and using durable medical equipment (DME), Minimum of 3 years of clinical work in orthopedics, physical rehab or case management, Experience in an outpatient or inpatient setting, NJ Nurse Practitioner (NP) or Advanced Nurse Practitioner Nurse (ANP) license, Experience as an Advanced Nurse Practitioner (ANP) with ICU and/or ER experience, Previous Counseling / Advising experience, Self-motivation, organization and flexibility, Commitment to improve care in underserved populations, Home care, long term care, care management experience, Knowledge of the case management and utilization review process $, Registered Nurse licensure in New York State, A minimum of two (2) to three (3) years of clinical experience in a certified Home health agency (CHHA), Lombardi program and/or MLTC, Excellent communication, written and analytical skills, Serves as a point of contact for internal and external clients including: screening phone calls, ensuring client messages are communicated to the appropriate client service staff, and following up with clients, when appropriate, Provides general administrative support to partners, including but not limited to, High School Diploma/GED required; College coursework/degree preferred, A minimum of 2 years of experience in an administrative role is required, Experience in a professional services firm preferred, Capability to work in a fast paced environment and under pressure, Advanced skills with Microsoft Office, specifically Outlook & Excel, Experience in accounting procedures preferred, Flexibility with overtime to meet deadlines, Familiar with either CAP or NYS Point of Care (POC) requirements, Experience as a Chemistry Supervisor, Hematology Supervisor, Coagulation Supervisor, or CORE lab supervisor, Able to multi-task and enjoy working in a fast-paced, team environment, 2+ years of Clinical background and experience, Knowledgeable with assessments, and work in a fast-paced environment, PRI certified and have Utilization and/or Concurrent Review experience with an acute care facility, Develop/manage the patient care transition process which includes coordinating, facilitating and assisting patients throughout the episode of care, Serve as clinical resource with expertise in musculoskeletal patient care management and serve as liaison regarding services for this patient population, Oversee the process for clinical pathway development, staff training, and data collection and reporting, Act as a positive role model as a nursing leader, 3+ years of related experience as a medical/surgical nurse, 2 years of UM or case management experience, Strong ability to develop, guide, motivate, nurture, and coach others, Dealing with Medicaid/Medicare members, perform pre-admission, concurrent and retrospective reviews to evaluate appropriateness of admission, need for continued stay, length of stay, utilization of resources, patient outcomes, and usage of other services post-encounter, Document all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards to insure integrity of member services, Identify opportunities and facilitate member transfers to: a) hospital of enrollment/other appropriate in-network hospital when hospitalization occurs out-of-network; or b) hospital of enrollment when hospitalization occurs at another network hospital, 5+ years relevant UM or Case Management experience, LMSW, LCSW, Mental Health Counselor, or RN license, Experience with mental health and substance abuse, Psych, Discharge Planning, Chemical Dependency, CCM, Case Management, Behavioral, Ambulatory, Care management experience in prenatal service/obstetrical care management, IVF experience or IVF case management experience, Proficiency in Utilization Review, OB/GYN, IVF/Infertility, and Case Management, 3+ years of experience in an Outpatient, Orthopedic, or Acute Care setting, Previous Managed Care and Pain Management experience, Utilization and/or Concurrent Review experience, Advocates for the members’ needs, addresses concerns and resolves, Facilitates the completion of Medicaid and other benefits programs eligibility application process for members and monitors the process, Attends a minimum of one networking event each month to promote AEC services within the community, Bachelor’s Degree in Social Work, Sociology, Psychology, Gerontology or a related field, Two or more years of case management experience, Valid Driver’s License and current auto insurance, Complete needs surveys regarding psychological, emotional and environmental resources, for the purpose of providing appropriate, timely interventions to ensure provision of optimal care, Coordinate community care and services as deemed appropriate, Work collaboratively with other members of the Humana At Home Interdisciplinary team-to include: Humana At Home Care Managers, Field Care Managers, and Community Health Educators, Minimum 3 years of care/case management experience with adults, Knowledge of community health, community resources, and social service agencies, Ability to interact effectively with multi-disciplinary team members, Self-starter who is able to multi-task and prioritize, Must have a separate room with a locked door that can be used as a home office to ensure you and our members have absolute and continuous privacy while you work, Must have accessibility to high speed DSL or Cable modem internet for your home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance form Humana systems is 10M X 1M, Ability to work a full-time (40 hours minimum) flexible work schedule, Previous work with vulnerable adults or geriatric population, Licensed in your residential state (ND, SD, NV, UT, LA, AL, OK), Ability to work a full-time (40 hours minimum) Monday - Friday, Central and mountain time zones would be a plus, 3 years of experience in home case/care management, MUST LIVE within 10-15 MILES of Hampton, VA, Valid Registered Nurse (RN) with no disciplinary action in the stateof TEXAS, One year of field based eldercare with Home Care and/or caremanagement environment, This role is considered to patient and is a part of Humana At Home Tuberculosis(TB) screening program. Identifies members to refer to the JSA Disease Management/High Risk Programs, Reviews medical and pharmacy claims monthly and discusses findings with the PCP. Utilize individual Member medical, behavioral, pharmacy and utilization data to co-create, with Members’ individual crisis plans and coordinate their care, Implements the comprehensive plan of care. Communication may include patient (or agent), attending/referring physician, and facility administration as necessary, Initiate and/or oversee data entry into IS systems on all patients within 24 hours of patient contact. Prepares quarterly grant reports for the Foundation and individual grantors of the Project, Provide leadership to the Integrated Project staff (three LCSW's at the three Family Health Centers), including planning, directing, and implementation of project initiatives. Interviewed clients individually and with families to determine what services would best address their needs. The nurse case manager resume example opens with a summary highlighting Maye's expertise in oncology, cardiac step-down units, surgical, and neurological intensive care units.The section titled "Areas of Expertise" features keywords used emphasize her related medical expertise, including cardiac Medical Surgical floor in a hospital) and/or home care required; behavioral health experience preferred, 3 to 5 years of Case Management experience within a managed care organization preferred; telephonic case management experience preferred, Demonstrated ability to assess and engage adult members/patients in the case management program/process, Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer, Monitors inpatient, outpatient, and SNF patients and initiate patient care arrangements. Demonstrates flexibility in areas such as job duties and schedule in order to aid Care Center in better serving its members and to help the company achieve its business and operational goals. 1,676 Opwdd jobs available on Advocating for individual needs as indicated; 5.3. Must have and maintain current, valid and unrestricted RN License that meets licensure requirement for the state in which you practice, Experience providing service coordination and information, linkages, and referrals for community-based services, 2+ years of experience in a Clinical Acute Care position; 1+ year of experience in Care / Case Management, Microsoft Office/Suite proficient (Excel. Insures that all appropriate informational release situations are invoiced at the allowable fee. Works with community agencies as appropriate. Social Worker Resume Objective. ), Provides individual client focused reports accentuating case management activity and outcome, Establishes a network of community resources (i.e., hospital discharge planners, AIDS counselors) necessary for providing appropriate care to patients, Serves as a program advocate by conducting training sessions, offering presentations, visiting providers, etc, Negotiates rates with vendors according to company policies and procedures, Facilitates the flow of claims through the Healthcare Management Department, Provides input (data, analysis or opinion) to the evaluation of the Program’s overall effectiveness, Make recommendations for system development from a user’s perspective, Participates in Quality Management initiatives, Complies with Healthcare Management policies and procedures and conforms to American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission standards while performing the job function, Reviews and signs CoreSource Confidentiality Attestation at the time of employment and at each annual performance review, Maintains active state nursing license and continuing education requirements and submits original copies of each to be photocopied for the employee file, Other duties as assigned by a Healthcare Management Supervisor or Director of Healthcare Management, Experience working with the Mental Health and/or Psychiatric population, Utilization Review or Discharge Planning background, Active New York State Registered Professional Nurse license, Experience working in any of the following areas: Geriatrics, Discharge Planning, Case Management, Assessment, Acute, Sub-Acute, Long-Term Care (LTC), Health insurance, Home care environment, Homeless population, Addiction, Foster care, Proficiency in navigating the Internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling), Intermediate skills with a Corporate email system including using and sharing calendar rights, MS Word, MS Excel and electronic patient health information (PHI) database usage (medical records database), Experience working with a frail adult or elderly population, Care management knowledge, including the concepts and philosophy and relevant standards of patient care, Experience with multiple Medicaid managed care plan products such as, Family Health Plus (FHP), Eastern Benefits System (EBS), Federal Employee Program (FEP), Experience: Three years of Clinical Nursing Experience, License: RN License in the state of Michigan, Skills & Abilities: Knowledge of chronic disease, evidence-based guidelines, prevention, wellness, health risk assessment, and patient education. Ensures and/or coordinates counseling and teaching for discharge preparation, Ensure that the appropriate outside agencies are contacted and necessary referrals are initiated and followed through. ), Independent clinical license required, LPC, LMSW or RN, Strong computer skills including MS Office, Excel, Word and Outlook. Sensitive to cultural diversity and low literacy issues in care provision, Managed Care experience (Case Management & Discharge Planning), Associate's Degree in Nursing for a candidate with an active RN License, A Master's Degree for a candidate with a LCSW or LPCC, Licensed Professional Clinical Counselor (LPCC), Assume responsibility in coordinating care to assigned clients, establishing a goal directed care plan from admission to discharge which includes a comprehensive ongoing assessment of clients’ needs, Perform on site supervisory visits to assess client, family, environment, and clinical care givers and complete follow-up documentation, Ensure availability and proper operation of necessary equipment and supplies related to patient care, Promote and manage expectations and satisfaction with internal and external customers, Evaluate the quality and effectiveness of nurse practice and nursing services, analyzing appropriate data and information to identify opportunities for collaboration with all stakeholders in order to improve services and patient outcomes, Provide nursing updates and obtain re-authorization for continued care, Provide ongoing supervision, orientation, training, education, and evaluation of clinical field staff, Identify professional practice standards within the organization and identify areas of strengths as well as areas for professional practice development, Contribute to nursing education and professional development of staff, students, and colleagues, Participate in employment decisions affecting nursing staff, including hiring and termination as appropriate, Maintain compliance in accordance with company policies and procedures, laws and regulations, and professional standards within the state of practice, Maintain a professional demeanor consistent with registered nurse standards of practice, Provide best practice in delivery of nursing care to the appropriate population and adhere to the standards of professional nursing practice, Base decisions and actions on ethical principles and foster a non-judgmental, non-discriminatory climate in which care is delivered in a manner sensitive to socio-cultural diversity, Participate in call for after hour’s client care, Promote an environment of quality and safe client care through participation, development, and adherence to the QA plan and associated activities and metrics, If supervising Private Duty has a minimum of two years experience in private duty, home care, or health care and the knowledge, experience and ability to effectively administer the private duty program, Perform other duties as assigned by supervisor, Proof of eligibility to work in the United States, RN licensure in designated states as appropriate, Knowledge and understanding of compliance with adherence to regulations, Diploma, Associate, or Bachelor degree in nursing from state accredited RN program, Ability to assess clients and provide direct client care as needed, Valid Driver’s license and Acceptable MVR, At least 2-5 or more years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required. 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