How Much Does A Case Manager Make A Year Jobs in Usa

Make a Difference on Your Own Schedule and Terms!

PCM is looking for a Senior Case Manager who is as passionate about delivering care as we are to come join our amazing team!

A few of our perks:

• Great Work/Life balance!

• $42 per hour (including 100% of Hourly Wage Paid for Drive Time)

• Benefits Available:

  • Medical, Vision and Dental Insurance

  • Accrued Paid Time Off

  • Annual Bonus Eligible

  • Health Savings Account (HSA)

  • Flexible Savings Account (FSA)

  • 401(K) with Company Match

  • Paid Parental Leave

  • Unlimited Peer Referral Program

  • Employee Discount Program

We provide in-home care to former Nuclear Weapons Workers who are suffering from chronic and terminal illnesses, as a result of their previous work environment.

Our Senior RN-Case Managers Direct assigned team members of RN Case Managers in the provision of care in accordance with Agency policy and with state-specific nurse practice act, and regulatory requirements.

Qualifications

• Graduate of a state approved school of professional registered nursing

• BSN preferred

• Current, unrestricted RN license in the state(s) of practice

• Minimum of two (2) years nursing experience including one (1) year in home care or closely related field

• One (1) year of supervisory and/or case management experience preferred

• Current CPR certification

Essential Functions/Areas of Accountability

• Responsible for functions and accountabilities as contained in the case manager job description

• Provide direct care and case management of assigned clients

• Assist and collaborate with the regional director and other personnel to identify and correct issues and/or improve services.

• Plan, implement, and evaluate care provided Participate, coordinate and manage client care conferences as needed.

• Serve as a local on-site clinical resource as needed and provides support to ensure client's home care needs are met.

• Assist and collaborate with staffing coordinators regarding the appropriateness of staffing and scheduling of personnel within scope of practice, competencies, client needs and complexity of home care.

• Adhere to nursing delegation guidelines as described in Agency Scope of Practice policy.

• Ensure adherence to Agency policies.

• Perform other functions as requested by the regional director which may include the following:

• Participate in interviewing, selection, and ongoing evaluation of clinical personnel as requested by the Regional Director

• Personnel training, education, and competency validation

• Review and evaluate clinical documentation for accuracy and completeness

• Participate in all Agency performance improvement initiatives including but not limited to quarterly medical record review

• Collect, document, and submit data on infections, occurrences, complaints and grievances, and performance improvement activities

• Perform and document supervisory visits as indicated to facilitate problem resolution

• Review nurse shift reports for adherence to policy and for opportunities for performance improvement

• Home chart completeness

• Timeliness of staffing cases post referral

• Equipment tracking

• Assist with marketing activities such as visiting with clients or physicians to discuss Agency programs as requested

• The senior case manager, or similarly qualified alternate, shall be available at all times during operating hours and participate in all activities relevant to the professional services furnished, including the development of qualifications and the assignment of personnel.

• Perform additional duties and responsibilities as deemed necessary

Professional Case Management is an Equal Opportunity Employer.

Conducts comprehensive clinical reviews of adverse determinations related to medical necessity.

Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.

Provides support for claim appeals in relation to medical necessity.

Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.

Facilitates member second level appeal process.

Graduate from an accredited school of professional nursing is required.

BSN preferred.

Minimum 2 years acute care experience or managed care experience is required.

Basic knowledge of Medicaid, Medicare preferred.

Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.

Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.

Active Certification in Case Management (CCM) is preferred.

Were unique. You should be, too.

Were changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

Were different than most primary care providers. Were rapidly expanding and we need great people to join our team.

The Nurse Case Manager 1 (RN) is responsible for achieving positive patient outcomes and managing quality of care across the continuum of care. The incumbent in this role will first and foremost serve as an advocate for our patients. He/She works closely with other members of the care team to develop effective plans of care and high levels of care coordination. This care planning and coordination may follow the patient from our centers into acute and post-acute facilities, as well as, their home environments. The Nurse Case Manager 1 (RN) role also involves establishing relationships with patients families and care givers, primary care physicians, specialists, other care providers, social workers, other case managers and nurses, acute and post-acute facilities, home health care companies, and health plans. He/She adheres to strict departmental goals/objectives, standards of performance, regulatory compliance, quality patient care compliance and policies and procedures.

CORE JOB DUTIES/RESPONSIBILITIES:

• Manages and plans for transitions of care, discharge and post discharge follow-up for patients admitted to key, high-volume/high-priority hospitals.
• Establishes a trusting relationship with patients and their caregivers.
• Collaborates with clinical staff in the development and execution of the plan of care and achievement of goals. Reports variations to PCP/Transitional Care Physicians (TCP) and implements actions as appropriate.
• Builds relationships with preferred acute care providers (hospitalists, specialists, etc.).
• Directs referrals to preferred providers.
• Coordinates the integration of social services/case management functions in the pre-acute, ER, acute and post-acute setting. Coordinates the patient care, discharge and home planning processes with hospital case management departments, and other healthcare facilities.
• In conjunction with the PCP, Hospitalist, Medical Director, insurance case manager and the hospital case manager, coordinates the patient transition to the appropriate/least constrictive level of care using a preferred provider.
• Keeps the PCP aware of patient(s) condition via e-mail, DASH, HITS or other appropriate means of communication.
• Introduces self to patient/family and explains Nurse Case Managers role and processes to contact the Nurse Case Manager for questions, guidance and education.
• Provides high intensity engagement with patient and family.
• Facilitates patient/family conferences to review treatment goals and optimize resource utilization; provides family education and identifies post-hospital needs.
• Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient/familys ability to make informed decisions.
• Addresses advanced care planning including treatment goals and advance directives.
• Refers cases to social worker (Hospital and ChenMed/JenCare/Dedicated) for complex psychosocial and economic needs.
• Refers cases where patient and/or family would benefit from counseling required to complete complex discharge plan to social worker.
• Reports observed or suspected child or adult abuse pursuant to mandated requirements.
• Obtains onsite and EMR access at priority facilities.
• Maintains clinical and progress notes for each patient receiving care and provides progress report to PCP and others as appropriate.
• Submits required documentation in a timely manner and in appropriate computer system.
• Participates in surveys, studies and special projects as assigned.
• Conducts concurrent medical record review using specific indicators and criteria as approved by medical staff. Acts as patient advocate: investigates and reports adverse occurrences, and performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.
• Promotes effective and efficient utilization of clinical resources and mobilizes resources to assist in achieving desired clinical outcomes within specific timeframe.
• Conducts review for appropriate utilization of services from admission through discharge. Evaluates patient satisfaction and quality of care provided.
• Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship. Assists physicians to maintain appropriate cost, case and desired patient outcomes.
• Coordinates the provision of social services to patients, families and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services.
• Completes expanded assessment of patients and family needs at time of admission. Completes psychosocial assessment.
• Directs and participates in the development and implementation of patient care policies and protocols to provide advice and guidance in handling unusual cases or patient needs.
• Attends meetings as assigned
• Performs other duties as assigned and modified at managers discretion.

There are 4 Nurse Case Manager 1 Roles with additional Essential Job Functions:

Acute Case Manager (primarily hospital based)

Responsibilities include all the above Core duties/responsibilities plus the following:

• Identify appropriateness of inpatient vs. observation status.
• Identify and manage safety risk (complete a social assessment), identify functional status (ADLs and PT needs), discuss medications and self-management, identify and correct knowledge deficits.
• Implement the ACM Coaching program with the appropriate patient population.
• In markets as appropriate, when patient in SNF, in conjunction with the post-acute physician, coordinate the transition to a lower level of care as soon as appropriate using a preferred provider if further services are needed.
• Facilitate discharge to appropriate level of care and preferred providers
• Communicate discharge to all stakeholders including PCP, Center Manager and Community Case Manager.
• Document the appropriate date that the patient is medically discharged and update as appropriate.
• Contact the center manager to arrange for a follow-up PCP appointment prior to discharge and whenever possible, communicate this information to the patient/caregiver.
• As appropriate, discuss patients eligibility for CCM or DM programs and identify patient interest in participation.
• Coordinate acute UR physician meetings.

Community Case Manager (primarily clinic and community based)

Responsibilities include all the above Core duties/responsibilities plus the following:

• Provides telephonic or outpatient visits to patients at high-risk for readmissions (as identified by CM Plan) to the ER or hospital, to patients with active care planning requirements, to disease management patients per the Disease Management Plan and to others as referred via transitional care team, acute case managers and Transitional Care team.
• Visits may include evening and weekend hours with the goal of preventing ER visits or hospital admissions.
• Performs clinical functions including disease-oriented assessment and monitoring, medication monitoring, health education and self-care instructions in the outpatient setting.

Coordinate the Plan of Care:

• Conducts/coordinates initial case management assessment of patients to determine outpatient needs.
• Ensures individual plan of care reflects patient needs and services available.
• Makes recommendations to the team.
• Completes individual plan of care with patients and team members.
• Communicates instructions and methodologies as appropriate to ensure that the plan is implemented correctly.
• Assesses the environment of care, e.g., safety and security.
• Assesses the caregiver capacity and willingness to provide care.
• Assesses patient and caregiver educational needs.
• Coordinates, reports, documents and follows-up on Super Huddles and HPP/IDT meetings.
• Helps patients navigate health care systems, connecting them with community resources; orchestrates multiple facets of health care delivery and assists with administrative and logistical tasks.
• Coordinates the delivery of services to effectively address patient needs.
• Facilitates and coaches patients in using natural supports and mainstream community resources to address supportive needs.
• Maintains ongoing communication with families, community providers and others as needed to promote the health and well-being of patients.
• Establishes a supportive and motivational relationship with patients that support patient self-management
• Monitors the quality, frequency and appropriateness of HHA visits and other outpatient services.
• Assists patient and family with access to community/financial resources and refer cases to social worker as appropriate.

Community/Skilled Nursing Facility Case Manager (Community Case Manager Role with additional SNF duties as assigned)

Responsibilities include all the above Core duties/responsibilities plus the following:

• Community Case Manager role as above.
• CM telephonic or onsite visits to SNFs, communication with physical therapists (PT), social workers, patient and families as appropriate.
• Validates appropriate level of care/LOS.
• Validates Discharge plan for safe transition home, utilization of preferred providers or timely transition to long term care.
• Reminds patient of need for 4-day PCP post hospital/SNF discharge visit and future visits.
• Collaborates with payor onsite SNF CMs.

Transitional Case Manager (Blended Acute and Community Case Manager Roles)

Responsibilities include all the above Core duties/responsibilities plus the following:

• Acute and Community Case Manager roles as above.

KNOWLEDGE, SKILLS AND ABILITIES:

• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Critical thinking skills required.
• Ability to work autonomously is required.
• Ability to monitor, assess and record patients progress and adjust and plan accordingly.
• Ability to plan, implement and evaluate individual patient care plans.
• Knowledge of nursing and case management theory and practice.
• Knowledge of patient care charts and patient histories.
• Knowledge of clinical and social services documentation procedures and standards.
• Knowledge of community health services and social services support agencies and networks.
• Organizing and coordinating skills.
• Ability to communicate technical information to non-technical personnel.
• Proficient in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software.
• Ability and willingness to travel locally, regionally and nationwide up to 10% of the time.
• Spoken and written fluency in English.
• Bilingual preferred.

PAY RANGE:

$36.9 - $52.70 Hourly

The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.

EMPLOYEE BENEFITS

Were ChenMed and were transforming healthcare for seniors and changing Americas healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. Were growing rapidly as we seek to rescue more and more seniors from inadequate health care.

ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in peoples lives every single day.

Current employees, if you want to apply to our internal career site, please click HERE

Current Contingent Worker please see job aid HERE to apply

#LI-Onsite

Required

Preferred

Job Industries

• Other

• 
  
• Medical: Multiple plan options.
  
• Dental: Delta Dental or reimbursement account for flexible coverage.
  
• Vision: Affordable plan with national network.
  
• Pre-Tax Savings: HSA and FSAs for eligible expenses.
  
• Retirement: Competitive retirement package to secure your future.
  

The Registered Nurse (RN) Case Manager works within an interdisciplinary team to facilitate the patient plan of care throughout the continuum of care by ensuring appropriate utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which includes accountability for assessing, planning, implementing, evaluating, and communicating the patient care plan progression. The RN Case Manager utilizes the principles of mutual respect, patient/family advocacy and provides leadership within the team of internal partners and outside agencies to facilitate best practices that achieve quality clinical, financial, and patient satisfaction outcomes. The RN Case Manager provides leadership through education on case management/utilization management concepts, committee work, research, and community involvement. The RN Case Manager bridges communication between providers, patients and families, members of the interdisciplinary team, and outside agencies to assure high-quality care that meets the patient's needs and is delivered in a cost-effective and timely manner. The ANA Nursing: Scope and Standards of Practice and Code of Ethics provide a basis for the practice of the RN. The American Case Manager Association Standards of Practice and Scope of Services for Health Care Delivery System Case Management and Transitions of Care Professionals (2013) are reflected. 

This role is eligible for TN sponsorship. 

Arizona: Graduate of an accredited, or those in the candidacy process, baccalaureate nursing program, as recognized by the Accreditation Commission for Education in Nursing (ACEN), Commission on Collegiate Nursing Education (CCNE), National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). If graduated from a nursing program that was not accredited by ACEN,CCNE, and NLN CNEA, at least one year of RN experience in an applicable care setting is required. If graduation did not occur within the last two years, one year of RN experience in an applicable care setting is required or, effective October 1st, 2017 one year of current LPN experience at Mayo Clinic is required. One year of RN Case Management experience or successful completion of the MCSHS RN Case Manager Fellowship within six months of hire required.

 

• 3 years of acute nursing preferred; 1 year of Case Management experience preferred. Certification (CCM or ACM-RN) preferred. 
• Current RN license by applicable state requirements. 
• Arizona - Maintains Basic Life Support (BLS) competency. 
• Positions that are not on campus may not require current Basic Life Support (BLS) competency as determined by the work area.
• Additional state licensure(s) and/or specialty certification/training as required by the work area.
• Previous hospital case management experience preferred.                        
   

Location: CHA Everett Hospital 
Work Days: Mon - Friday and Rotating Weekends/Holiday
Category: Registered Nurse
Department: Inpatient Case Management Everett  
Job Type: Part Time
Work Shift: Day 
Hours/Week: 24.00 
Union Name: MNA Everett

Department Description

Inpatient Case Management provides psychosocial assessments, evaluations, and referrals for adults, and/or families with psychiatric illness, substance abuse, and medical illness. Casework or therapy takes place in the hospital setting. Cross Training to all areas of Care Management.

Under the general supervision of the Director of Care Management, the RN Case Manager provides clinically-based case management to support the delivery of effective and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case Manager will collaborate with other members of the health care team to identify appropriate utilization of resources and to ensure reimbursement. Utilize criteria to confirm medical necessity for admission and continued stay. With the patient, family and health care team, create a post-acute care plan appropriate to the patient's needs and resources and facilitate this transition in concert with that patient's inpatient and post-acute care teams. 

Qualifications/Requirements:

• BSN preferred
• Current or Conditional MA RN Licensure 
• Current American Heart Association (AHA) for Healthcare Providers BLS (Basic Life Support) certification is required 
• Licensure and Certifications: 
• Certification in Case Management preferred

Please note that the final offer may vary within the listed Pay Range, based on a candidate's experience, skills, qualifications, and internal equity considerations.

In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment. 

Cambridge Health Alliance brings Care to the People - including your neighbors, friends and family. Our local hospitals and care centers serve our vibrant, diverse communities, and play an integral role in improving health. As passionate advocates for the underserved, we actively partner with our communities to take on challenging public health issues, and conduct important research to help reduce barriers to care. We believe that everyone deserves access to high quality, convenient health care. This is why our employees believe in where they work and why many build long, rewarding careers at CHA.

Healthcare is changing rapidly. CHA has a strategic plan that charts a proactive course for our future. It is built on a vision of equity and excellence for everyone, every time. It also recognizes that our workforce is our most valuable asset and prioritizes competitive salaries, benefits and professional development opportunities for employees. The strategic plan is changing the way we provide care and improving the health and experience of our patients; we are looking for smart, committed, compassionate people who want to be part of making our vision of better health and equity a reality.

At CHA, you can believe in where you work and go home every day knowing you made a difference. Join our team and help us bring Care to the People.

Bilingual Case Manager (English/Spanish) – Personal Injury

Miami, FL | Temp-to-Hire | Monday–Friday, 8:00 AM – 5:00 PM

We are seeking a dedicated and detail-oriented Bilingual Case Manager with personal injury experience to join our team in Miami, FL. This is a temp-to-hire opportunity with a consistent weekday schedule and the chance to join a supportive, fast-paced legal environment focused on helping injured clients navigate their medical and legal processes.

About the Role:

As a Case Manager, you will play a key role in coordinating Examinations Under Oath (EUOs) and Independent Medical Exams (IMEs) while managing ongoing communication and documentation for personal injury cases. Your ability to handle sensitive information, communicate effectively in both English and Spanish, and manage detailed casework will directly impact the success of our clients’ outcomes.

Key Responsibilities:

• Schedule and coordinate EUOs and IMEs; send timely and accurate notices to all involved parties
• Maintain ongoing follow-up with clients regarding treatment updates and case progress
• Request, receive, and organize medical records and billing documentation
• Review and analyze medical documentation for accuracy and completeness
• Communicate regular case status updates to clients
• Maintain well-organized, confidential, and compliant case files

Requirements:

• Minimum 1 year of personal injury case management experience
• Bilingual – fluent in English and Spanish (written and verbal)
• Strong organizational skills with high attention to detail
• Excellent communication and customer service skills
• Ability to manage confidential information with discretion
• Must be able to start immediately
• Comfortable working Monday through Friday, 8:00 AM to 5:00 PM