How Much Does A Case Manager Make Jobs in Usa

POSITION SUMMARY/RESPONSIBILITIES

The nurse case manager coordinates, in collaboration with the patient and interdisciplinary team, the treatment/ plan of care for a patient within the acute episode of care. He/she proactively facilitates interventions to assure timely delivery of services, evaluates the effectiveness of interventions, tracks variances and/or barriers in the plan of care, and functions as the patient advocate to identify and communicate health care needs.

EDUCATION/EXPERIENCE

Bachelor's degree in Nursing is highly preferred. Three to five years nursing experience required. Work experience in case management, utilization review or hospital quality is preferred.

LICENSURE/ CERTIFICATIONS

Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred. Current American Heart Association, Basic Cardiac Life Support and/or Health Care Provider card preferred.

Schedule:

• Monday-Friday, flexible day shift hours
• Unit support/coverage as needed

The Case Manager coordinates care across an episode and/or the continuum for clients with complex problems and diverse needs.  The Case Manager’s focus is to maintain patients at an optimal level of health and to support self-care.  Case Managers collaborate with physicians, social services, nurses, and community agencies to define care options and resources, to plan cost effective quality care and to achieve optimal outcomes. 

Specific responsibilities include case screening, insurance approval, assurance of timely services, and facilitation of discharge with transition to the appropriate services.  Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines.  Works proactively to coordinate the services of physicians, nurses, and other disciplines to effectively prepare patients for discharge.  The Case Manager facilitates program development, efficient care delivery processes and quality improvement including tracking of resource utilization and outcome measures.  The Case Manager is accountable for improving service using cost and quality outcome data, current clinical practices and related research, regulatory requirements and comparative benchmark opportunities.   

Customers include patients, families/visitors, physicians, physician assistants, nurse practitioners, case managers, representatives of third-party payers, representatives of referring agencies, interdepartmental and intradepartmental staff, vendors, and volunteers.     

Actively knows, understands, incorporates, and demonstrates the organization’s mission and core values, including the Guiding Behaviors and Caring Model Principles, and always conducts oneself in a manner consistent with these values.  

Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior. 

• Demonstrates knowledge, skills and abilities to provide case management services appropriate to the age of patients served. 

• Exhibits sound judgment, critical thinking, problem solving and decision-making skills. 

• Communicates effectively with patients, significant others, and members of the health care team.  

• Compiles information; keeps records, prepares or directs preparation of reports and correspondence. 

• Executes daily utilization functions for assigned patients, including prior authorization, admission, precertification/certification/recertification, concurrent and retrospective review, associated analysis, and referral appropriateness.  

• Participates in comprehensive team meetings and conferences regarding specific patient needs that affect cost, quality, and length of stay.  Demonstrates ability to promote collaboration and creativity among members of the health care team. 

• Responsible for assuring thorough case management assessment, as well as early and ongoing discharge plans by collaborating with patients, families, physician, payors, and providers across the continuum of care.   

• Reports potential catastrophic and high-cost cases to department director, nursing director, and finance department for appropriate medical/administrative review and management. 

• Effectively manages length of stay and cost avoidance.   

• Discuss cases with Utilization Review Committee and/or Executive Health Resources (EHR) when cases fail to meet admission, treatment, and length of stay and/or discharge standards.  

• Attends meetings of the Utilization Review Committee and submits reports as required.  Participates in the development of a written plan that describes the Utilization Review Program. 

• Applies quality improvement methods and techniques to improve case management processes to maximize cost and quality benefits for MercyOne Medical Center.  

• Performs other duties consistent with the purpose of the job as directed. 

• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. 

• Must be a registered nurse and must hold an active license to practice nursing in the state of Iowa. 

• Knowledge of clinical practice and case management processes normally acquired by completing a bachelor’s degree in nursing. 

• Training and/or Certification in the area of case management is preferred.   

• Must meet all mandatory education and training requirements within specified timeframes as required by organizational/regulatory standards. 

• Three to five years’ clinical experience required.   

Schedule:

• Monday-Friday, flexible day shift hours
• Unit support/coverage as needed

The Case Manager coordinates care across an episode and/or the continuum for clients with complex problems and diverse needs.  The Case Manager’s focus is to maintain patients at an optimal level of health and to support self-care.  Case Managers collaborate with physicians, social services, nurses, and community agencies to define care options and resources, to plan cost effective quality care and to achieve optimal outcomes. 

Specific responsibilities include case screening, insurance approval, assurance of timely services, and facilitation of discharge with transition to the appropriate services.  Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines.  Works proactively to coordinate the services of physicians, nurses, and other disciplines to effectively prepare patients for discharge.  The Case Manager facilitates program development, efficient care delivery processes and quality improvement including tracking of resource utilization and outcome measures.  The Case Manager is accountable for improving service using cost and quality outcome data, current clinical practices and related research, regulatory requirements and comparative benchmark opportunities.   

Customers include patients, families/visitors, physicians, physician assistants, nurse practitioners, case managers, representatives of third-party payers, representatives of referring agencies, interdepartmental and intradepartmental staff, vendors, and volunteers.     

Actively knows, understands, incorporates, and demonstrates the organization’s mission and core values, including the Guiding Behaviors and Caring Model Principles, and always conducts oneself in a manner consistent with these values.  

Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior. 

• Demonstrates knowledge, skills and abilities to provide case management services appropriate to the age of patients served. 

• Exhibits sound judgment, critical thinking, problem solving and decision-making skills. 

• Communicates effectively with patients, significant others, and members of the health care team.  

• Compiles information; keeps records, prepares or directs preparation of reports and correspondence. 

• Executes daily utilization functions for assigned patients, including prior authorization, admission, precertification/certification/recertification, concurrent and retrospective review, associated analysis, and referral appropriateness.  

• Participates in comprehensive team meetings and conferences regarding specific patient needs that affect cost, quality, and length of stay.  Demonstrates ability to promote collaboration and creativity among members of the health care team. 

• Responsible for assuring thorough case management assessment, as well as early and ongoing discharge plans by collaborating with patients, families, physician, payors, and providers across the continuum of care.   

• Reports potential catastrophic and high-cost cases to department director, nursing director, and finance department for appropriate medical/administrative review and management. 

• Effectively manages length of stay and cost avoidance.   

• Discuss cases with Utilization Review Committee and/or Executive Health Resources (EHR) when cases fail to meet admission, treatment, and length of stay and/or discharge standards.  

• Attends meetings of the Utilization Review Committee and submits reports as required.  Participates in the development of a written plan that describes the Utilization Review Program. 

• Applies quality improvement methods and techniques to improve case management processes to maximize cost and quality benefits for MercyOne Medical Center.  

• Performs other duties consistent with the purpose of the job as directed. 

• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. 

• Must be a registered nurse and must hold an active license to practice nursing in the state of Iowa. 

• Knowledge of clinical practice and case management processes normally acquired by completing a bachelor’s degree in nursing. 

• Training and/or Certification in the area of case management is preferred.   

• Must meet all mandatory education and training requirements within specified timeframes as required by organizational/regulatory standards. 

• Three to five years’ clinical experience required.   

Immediate need for a talented Registered Nurse – Case Manager/ Utilization Manager. This is a 03+ months contract opportunity with long-term potential and is located in San Francisco, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.

Job ID: 26-01370

Pay Range: $80- $95/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Perform daily pre-admission, admission, and concurrent utilization reviews
• Determine appropriate levels of care using clinical guidelines and policies
• Coordinate inpatient discharge planning and transitions of care
• Participate in multidisciplinary rounds with physicians and care teams
• Communicate discharge plans with patients, families, and external providers
• Arrange transfers, post-acute services, and obtain authorizations as needed
• Ensure continuity of care through accurate documentation and follow-up
• Maintain compliance with federal, state, and institutional regulations
• Educate care teams on utilization and care coordination processes

Key Requirements and Technology Experience:

• Skills-Inpatient Case Management & Discharge Planning
• Utilization Management / Utilization Review (UM/UR)
• Acute hospital experience (inpatient setting)
• Knowledge of CMS, DMHC, NCQA, TJC, HIPAA, EMTALA
• Strong interdisciplinary communication and care coordination
• Ability to independently manage inpatient caseloads
• Healthcare benefit interpretation and authorization coordination
• Graduate of an accredited school of nursing
• Diploma or Associate Degree in Nursing (ADN) required
• Active California RN License (Required)
• BLS Certification (Required)
• Minimum 2 years of experience in:
• Utilization Management
• Case Management
• Discharge Planning
• Recent acute inpatient hospital experience
• Ability to work rotating schedules and every other weekend
• Comfortable working in a Labor/Management Partnership environment
• Bachelor’s degree in Nursing or healthcare-related field
• Master’s degree in Case Management

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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Location Address:

Compensation Pay Range:

Summary:

How you grow, learn and thrive matters here.
• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system

Responsibilities:

• Identifies cases appropriate for case management. Educates providers and other PHS/PHP departments on case management services. Screens new referrals for case management appropriateness.
• Conducts in-depth assessment which includes, but is not limited to, psychosocial, physical, medical, environmental and financial parameters. Advocates for members in caseload
• Identifies cases appropriate for case management. Educates providers and other PHS/PHP departments on case management services. Screens new referrals for case management appropriateness.
• Conducts in-depth assessment which includes, but is not limited to, psychosocial, physical, medical, environmental and financial parameters. Advocates for members in caseload.
• Formulates, implements, coordinates, monitors, and evaluates strategies for patients and families collaboratively with members, families and health care teams. Develops, documents and implements plans which provide appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
• Actively participates in the development of clinical guidelines and pathways and incorporates processes into the role of case managers.
• Educates providers on health management strategies which can reduce need for one-on-one case management services. Educate physicians, nurses, ancillary support staff, patients, and families regarding case management role.
• Refers patients to appropriate inpatient, outpatient, and community resources.
• Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and patient satisfaction. Collect clinical path variance data that indicate potential areas for improvement of case and services provided within the system. Generates reports, which demonstrate efficacy through direct cost-savings and outcome measures.
• Complies with Case management Society of America Standards for Case Management Practice and with CCMC code of Professional Conduct for Case Managers.
• Performs other functions as required.

Qualifications:

*Associates Degree in Nursing

*State of New Mexico or Compact State Nursing License

*BLS certification REQUIRED at at time or hire

*Five years of experience in clinical nursing with a minimum of three to five in case management, utilization management, quality assurance, home care, community health, or occupational health.

*CCM certification within 3 years of hire. 

*Employee Health experience preferred. 

We're all about well-being, starting with yours.
Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.

Learn more about our employee benefits.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

We are seeking a FORGE Lead Case Manager/Co-Facilitator to join our team.

Starting Salary: $56,000 (Salary)

Contingent Upon Funding- External Research Project. Employment is contingent upon its continued grant support.

We are seeking a FORGE Lead Case Manager/Co-Facilitator to join our team. The University of Kansas School of Social Welfare (KUSSW) and its partner, Cornerstones of Care, will develop and deliver the project, Family Opportunity, Resilience, Grit, Engagement - Fatherhood (Kansas FORGE Fatherhood). Kansas FORGE Fatherhood will serve fathers and father-figures raising a child by improving outcomes in healthy relationships, parenting practices, economic stability, and receive support in accessing community resources to long-term success.

The FORGE Lead Case Manager/Co-Facilitator works under the direction of the Manager of FORGE Fatherhood Project and is responsible for delivering the proposed program model, which includes the evidence-based Strengthening Father Involvement (SFI) curriculum, the evidence-informed financial program Money Habitudes (MH), and individualizing training based on participant's goals and needs as identified in case management. Additionally, the FORGE Lead Case Manager/Co-Facilitator provides case management to fathers and works closely with the Case Managers to ensure participants build relationship skills, gain positive parenting skills, and move towards economic stability.

WHAT YOU WILL DO:

• 
  
• Facilitate workshops, creating a supportive, culturally responsive, and flexible learning environment for fathers
  
• Ensure program implementation supports methods for fathers to work collaboratively with spouses or co-parents.
  
• Provide oversight and guidance to FORGE Case Managers.
  
• Manage a case load of father participants, developing individualized plans to assist them in obtaining healthy relationships, positive parenting skills, and economic stability.
  
• Connect fathers with community resources to assist them in meeting personalized goals.
  

WHAT YOU WILL BRING:

Our ideal candidate will have 2-5 years of child and families services experience and the following:

• 
  
• Bachelor's degree in social work or other human service-related field.
  

• 
  
• Master's degree in social work or other human service-related field and 2-5 years of work experience in child and family services. Licensed by the Behavioral Sciences Regulatory Board to practice in Kansas (LBSW, LMSW, LSCSW, Professional Counselor, LMFT, and/or Alcohol and Drug Counselor) preferred.
  

• 
  
• A valid driver's license in the state you reside in, proof of current vehicle insurance, and reliable transportation.
  

WHO WE ARE:

Cornerstones of Care is a mental and behavioral health nonprofit certified in trauma-informed care that provides evidence-based prevention, intervention, treatment, and support services to help children and families improve their safety and health by making positive changes in their lives. Each year, our team empowers children and families in Kansas, Missouri, and beyond through three key service areas:

• 
  
• Youth & Family Support - We help youth gain independence through social and living support programs while empowering families with the skills and resources they need to become resilient and successful.
  
• Foster Care & Adoption - We reunify and unite families while recruiting and providing support to foster parents and youth in foster care.
  
• Education & Community Trainings - We help students achieve academic success while giving educators the tools to create safe learning environments to improve their students' behaviors and offer innovative learning opportunities to build and improve knowledge in the community.
  

CORNERSTONES OF CARE'S ORGANIZATIONAL COMMITMENTS:

• 
  
• Nonviolence - helping to build safety skills and a commitment to a higher purpose.
  
• Emotional Intelligence - helping to teach emotional management skills.
  
• Social Learning - helping to build cognitive skills.
  
• Open Communication - helping to overcome barriers to healthy communication, learn conflict management.
  
• Democracy - helping to create civic skills of self-control, self-discipline, and administration of healthy authority.
  
• Social Responsibility - helping to rebuild social connection skills, establish healthy attachment relationships.
  
• Growth and Change - helping to work through loss and prepare for the future.
  

OUR BENEFITS:

Cornerstones of Care offers a competitive benefits package, which includes:

• 
  
• 9 Paid Holidays, Unlimited Paid Time Off, and Paid Sick Leave
  
• Team members who work at least 30 hours per week are eligible for
  
  • 
    
  • Health insurance benefits (medical, prescription, dental, vision)
    
  • Cafeteria plans (Health Savings Account (HSA) and Medical and Dependent Care Flexible Spending Accounts)
    
  • Ancillary insurance benefits (accident insurance, critical illness insurance, hospital indemnity insurance, short-term disability insurance, voluntary life)
    
  • Cornerstones of Care provides long-term disability insurance and basic term life/AD&D insurance at no cost to the team member
    
  
  
  
• Retirement savings plan (401K) with employer match
  
• Pet Insurance
  
• Employee assistance program (EAP)
  
• Tuition reimbursement program
  
• Public Service Loan Forgiveness.
  
• To view more information on our benefits, please visit our Job Openings page at Join Our Team - Cornerstones of Care to download the current benefits guide.
  

Questions?

Please contact: Cornerstones of Care, People Experience Team

8150 Wornall Rd., Kansas City, MO 64114

Phone: Fax:

Like us on Facebook at: cornerstonescareers

Employment Conditions:

Contingent Upon Funding - External Research Project. The project is supported by grant number 90ZJ0128 from the Children's Bureau within the Administration of Children and Families, a division of the U.S. Department of Health and Human Services. Employment is contingent upon its continued grant support[1][PN1] .

Cornerstones of Care is an Equal Opportunity Employer

We are an equal employment opportunity employer without regard to a person's race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status, or genetic information.

[1] The production of this job posting was supported by Grant Number 90ZJ0128-1 from the Administration for Children and Families (ACF). Its contents are solely the responsibility of the University of Kansas and do not necessarily represent the official view of ACF.