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Director of Case Management
Job Type: Full-Time, Permanent
Location: Central Louisiana
Step into a high-impact leadership role where you can truly shape how patients move through the healthcare system. This Director of Case Management opportunity offers the chance to lead a collaborative team at a respected regional medical center serving a vibrant and growing community in central Louisiana. Known for its strong culture of teamwork and mission-driven care, this organization empowers leaders to innovate, improve patient outcomes, and build programs that make a meaningful difference across the continuum of care.
Responsibilities
- Lead and inspire a multidisciplinary Care Management team including Social Workers, RN Case Managers, and Utilization Review staff while fostering a culture of accountability, collaboration, and patient-centered care.
- Oversee the day-to-day operations of the Care Management department to ensure efficient patient flow, timely discharge planning, and appropriate utilization of resources.
- Develop and implement care management strategies that improve patient outcomes, reduce length of stay, and support effective transitions of care.
- Partner with executive leadership, physicians, finance, and operational teams to align care management initiatives with organizational goals and performance metrics.
- Ensure regulatory compliance with CMS and other governing bodies related to utilization review and discharge planning standards.
- Monitor and analyze department performance data to identify opportunities for improvement and implement cost-effective solutions.
- Manage departmental budgets and staffing while building strong clinical and operational processes.
- Represent Care Management initiatives across the organization and contribute to system-wide program development and best practices.
Qualifications
- Bachelor’s Degree required.
- Active RN or Licensed Social Worker (LCSW preferred) license in the state of employment or compact state.
- Minimum 3–5 years of acute care nursing or social work experience.
- At least 2 years of Case Management or Utilization Management experience.
- Minimum 3 years of leadership experience in a healthcare setting.
- Case Management Certification (ACM or CCM) preferred.
- Demonstrated success leading multidisciplinary teams and improving operational performance metrics such as length of stay or patient throughput.
- Strong communication, critical thinking, and problem-solving skills.
About the Hospital
- 300-bed regional medical center serving a large and diverse patient population.
- A key healthcare hub for central Louisiana with a broad range of specialty services.
- Collaborative leadership structure that values innovation and process improvement.
- Mission-driven culture focused on compassionate care and community impact.
- Strong emphasis on leadership development and system-wide collaboration.
Benefits
- Competitive compensation package with leadership-level salary.
- Performance bonus eligibility up to 12.5% of base salary through the organization’s incentive program.
- Comprehensive health, dental, and vision insurance options.
- Retirement savings plan with employer contributions.
- Generous paid time off and holiday schedule.
- Relocation assistance available for qualified candidates.
- Professional development and leadership growth opportunities.
Living in Central Louisiana
- Affordable cost of living with spacious homes, short commutes, and family-friendly neighborhoods.
- Easy access to lakes, rivers, and outdoor recreation including fishing, boating, and hiking.
- A vibrant local culture featuring Southern cuisine, music, and festivals throughout the year.
- Centrally located with convenient travel access to major Southern cities.
- Warm climate and welcoming community atmosphere that make it easy to feel at home.
If you're a strategic leader passionate about improving patient care and driving operational excellence, this is an opportunity to make a lasting impact. Apply today to learn more about leading Case Management at a respected regional healthcare organization.
Registered Nurse - Case Management
Ashland, WI
Specialty: Case Management
Position Type: Travel
Contract Length: 13 weeks
Pay: $2498 - $3009 | Shift: 5x8 Days
Are you a skilled Case Management RN looking for your next adventure? Do you thrive in an acute care setting, providing exceptional patient support? Our healthcare partner in Ashland, WI, is seeking a dedicated Registered Nurse to join their team on a travel assignment. This is your chance to make a meaningful impact while exploring a new community.
As a Case Management RN, you will play a crucial role in coordinating patient care and ensuring the best outcomes. Your responsibilities will include:
- Utilizing InterQual criteria to assess and plan patient care
- Collaborating with interdisciplinary teams to develop comprehensive care plans
- Facilitating patient transitions and discharge planning
- Documenting patient information using the EPIC charting system
- Maintaining BLS (AHA) certification
- Need 1 year experience in setting
Apply today and let Capstone Health help you reach your full potential! At Capstone, we know that when healthcare professionals feel supported, they provide the best care for their patients. That's why we offer personalized recruiter support and comprehensive benefits to help you build a fulfilling career while maintaining a healthy work-life balance. Our travelers enjoy a range of traditional and modern benefits, including:
- Dedicated Recruiter
- $1,000 Unlimited Referral Bonus
- Medical, Dental, and Vision Insurance
- Complementary Life Insurance
- 401(k)
- Lodging and Meals & Incidental Reimbursement (with qualified tax home)
- Licensure/Certification Reimbursement
- Voluntary Insurance Benefits
- Completion Bonus
- Equal Employment Opportunity
- And more!
Registered Nurse - Case Management
Ashland, WI
Specialty: Case Management
Position Type: Travel
Contract Length: 13 weeks
Pay: $2498 - $3009 | Shift: 5x8 Days
Are you a skilled Case Management RN looking for your next adventure? Do you thrive in an acute care setting, providing exceptional patient support? Our healthcare partner in Ashland, WI, is seeking a dedicated Registered Nurse to join their team on a travel assignment. This is your chance to make a meaningful impact while exploring a new community.
As a Case Management RN, you will play a crucial role in coordinating patient care and ensuring the best outcomes. Your responsibilities will include:
- Utilizing InterQual criteria to assess and plan patient care
- Collaborating with interdisciplinary teams to develop comprehensive care plans
- Facilitating patient transitions and discharge planning
- Documenting patient information using the EPIC charting system
- Maintaining BLS (AHA) certification
- Need 1 year experience in setting
Apply today and let Capstone Health help you reach your full potential! At Capstone, we know that when healthcare professionals feel supported, they provide the best care for their patients. That's why we offer personalized recruiter support and comprehensive benefits to help you build a fulfilling career while maintaining a healthy work-life balance. Our travelers enjoy a range of traditional and modern benefits, including:
- Dedicated Recruiter
- $1,000 Unlimited Referral Bonus
- Medical, Dental, and Vision Insurance
- Complementary Life Insurance
- 401(k)
- Lodging and Meals & Incidental Reimbursement (with qualified tax home)
- Licensure/Certification Reimbursement
- Voluntary Insurance Benefits
- Completion Bonus
- Equal Employment Opportunity
- And more!
Registered Nurse - Case Management
Ashland, WI
Specialty: Case Management
Position Type: Travel
Contract Length: 13 weeks
Pay: $2498 - $3009 | Shift: 5x8 Days
Are you a skilled Case Management RN looking for your next adventure? Do you thrive in an acute care setting, providing exceptional patient support? Our healthcare partner in Ashland, WI, is seeking a dedicated Registered Nurse to join their team on a travel assignment. This is your chance to make a meaningful impact while exploring a new community.
As a Case Management RN, you will play a crucial role in coordinating patient care and ensuring the best outcomes. Your responsibilities will include:
- Utilizing InterQual criteria to assess and plan patient care
- Collaborating with interdisciplinary teams to develop comprehensive care plans
- Facilitating patient transitions and discharge planning
- Documenting patient information using the EPIC charting system
- Maintaining BLS (AHA) certification
- Need 1 year experience in setting
Apply today and let Capstone Health help you reach your full potential! At Capstone, we know that when healthcare professionals feel supported, they provide the best care for their patients. That's why we offer personalized recruiter support and comprehensive benefits to help you build a fulfilling career while maintaining a healthy work-life balance. Our travelers enjoy a range of traditional and modern benefits, including:
- Dedicated Recruiter
- $1,000 Unlimited Referral Bonus
- Medical, Dental, and Vision Insurance
- Complementary Life Insurance
- 401(k)
- Lodging and Meals & Incidental Reimbursement (with qualified tax home)
- Licensure/Certification Reimbursement
- Voluntary Insurance Benefits
- Completion Bonus
- Equal Employment Opportunity
- And more!
Make a meaningful impact every day as a CenterWell Home Health nurse. You’ll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you’ll develop and manage care plans that support recovery and help patients get back to the life they love.
As a Home Health RN Case Manager, you will:
Provide admission, case management, and follow-up skilled nursing visits for home health patients.
Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager.
Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management, and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation.
Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides, and external providers).
Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis.
Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems.
Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflects current plan of care. Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility.
Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation.
Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records and confers with other health care disciplines in providing optimum patient care
Use your skills to make an impact
Required Experience/Skills:
Diploma, Associate, or Bachelor Degree in Nursing
A minimum of one year of nursing experience preferred
Strong med surg, ICU, ER, acute experience
Home Health experience is a plus
Current and unrestricted Registered Nurse licensure
Current CPR certification
Strong organizational and communication skills
A valid driver’s license, auto insurance, and reliable transportation are required.
Pay Range
• $49.00 - $69.00 pay per visit/unit
• $77,200 - $106,200 per year base pay
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About Us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Job Summary:
The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while promoting quality cost effective outcomes.
Essential Functions:
- Ensures consistent care along the entire health care continuum by assessing and closely monitoring members’ needs and status.
- Authorizes covered services and coordinates care regardless of payer.
- Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team.
- Works with member/family to maintain the most independent living situation possible
- Assesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings.
- Regularly assesses members for ongoing eligibility for services based on the specific plan’s eligibility criteria.
- Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs.
- Collaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member.
- Ensures appropriate, safe plan for members’ discharge from their plan.
- Identifies same day grievances, investigates and documents accordingly. Documents any grievance according to plan policy.
- Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).
- Responds to members’ requests in the designated timeframes and completes Initial Adverse Determinations (IAD) as indicated
- Identifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT including hospital or nursing home discharges planners, and formulates appropriate plan of care.
- Documents care management/coordination according to company policy to the specific plan the member is enrolled in, which may include monthly telephonic and in person recertification notes.
- Develops efficient plans of care, authorizing only needed services at the most appropriate levels, utilizing network providers and ensuring that services are based on members’ needs.
- Perform any other job related duties as requested.
Education and Experience:
- Associates degree in Nursing from an accredited nursing program required
- Bachelor's degree in Nursing preferred
- Three (3) years of experience as a registered nurse required
- Clinical experience in geriatrics and/or managed long-term care experience preferred
- Experience using multiple languages may be required based on operational needs
Competencies, Knowledge and Skills:
- Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
- Ability to communicate effectively with a diverse group of individuals
- Ability to multi-task and work independently within a team environment
- Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
- Adhere to code of ethics that aligns with professional practice
- Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice
- Strong advocate for members at all levels of care
- Strong understanding and sensitivity of all cultures and demographic diversity
- Ability to interpret and implement current research findings
- Awareness of community & state support resources
- Critical listening and thinking skills
- Decision making and problem-solving skills
- Strong organizational and time management skills
- Bilingual speaking and writing skills are preferred
Licensure and Certification:
- Current, unrestricted Registered Nurse licensure in the state of New York required
- Case Management Certification preferred
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
- Up to 25% (regular) travel may be required to travel to different locations, including homes, offices, or other public settings, to perform work duties
Compensation Range:
$100,000 - $115,000.. We takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
#AC1
#ACP
Position Title: Supported Living Program Case Coordinator
Location: Tempus Corporate Headquarters, 600 Technology Center Drive, Stoughton, Massachusetts, United States of America
Requisition Number: Req #263
Job Description
Tempus Unlimited, Inc. is a nonprofit organization that provides community-based services to empower children and adults with disabilities to live as independently as possible in the least restrictive environment. The agency, through its programs and services, encourages the inclusion of people with disabilities into the mainstream of society, including social, recreational, family and work activities.
As a Supported Living Service Case Coordinator, you will assist consumers with a variety of services and trainings to enable them to live independently in their community. Our program serves people from Boston to Southeastern Massachusetts. Case Coordinators are the difference in the lives of our consumers on a regular basis. Tempus takes a person-centered approach to all services.
Essential Functions
- Develop Supported Living Service Plans
- Maintain communication with the Personal Care Attendant (PCA) (or other service) provider.
- Assist consumers in the hiring, training, scheduling and supervision of their Personal Care Attendants, sign onto the PCA program Service Agreement if surrogacy is required. Be thoroughly detailed in the understanding of this document and assist consumer comply also.
- Assist Consumers in obtaining housing if needed.
- Assist consumers in setting up and maintaining appropriate records regarding Personal Care Attendants (PCA), finances and medical issues.
- Assist consumers with accessing community resources such as health care, recreation, transportation and adult education.
- Encourage and assist consumers in the development of relationships with other members of the community.
- Maintain confidential records according to program guidelines.
- Train consumers annually on human rights and how to obtain assistance on human rights violations.
- Assist consumers with Transitional Assistance services through the Money Follows the person (MFP) and Acquired Brain Injury (ABI) waivers.
- Follow MRC Community Living Program manual standards, as well as other regulatory documents related to the position.
- Must report all suspected incidents of consumer sexual/physical abuse and neglect to the Disabled Person Protection Commission (DPPC).
Job Requirements
Required Education
- Bachelor's degree and/or at least two years' experience serving people with disabilities
Competencies
- Familiarity with community services, the ability to understand and implement independent living philosophy and the ability to relate and empathize with people with disabilities and help them maximize their lives is required.
- Being resourceful to solve complex issues at times.
- Objective report writing.
Preferred Experience
- Training and supervisory experience is helpful.
- Significant experience in Personal Care Attendant (PCA) services, case management services, and disability service delivery systems is preferred.
- Good communication, organization and writing skills are required.
Work Environment
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical Demands. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk and/or hear. The employee is frequently required to sit; stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
Travel
This position requires an employee to be on the road as a primary function. Must have a valid driver’s license and reliable transportation.
Other Duties
Note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Benefits
Tempus Unlimited offers great benefits that foster a happy fulfilling human work experience. We also have an array of growth opportunities for our employees to develop your career and enhance your experience.
- Sign on bonus
- Work/Life Balance
- Paid time off - 25 days per year for full time staff
- 14 paid Holidays
- Tempus Wellness - Medical, Dental, Dependent Care Reimbursement, FSA and HSA
- Basic Life, Short Term and Long-Term Disability
- On-site gym (Stoughton Location) and wellness initiatives
- Annual Reviews with merit-based increases
- Employee Recognition Program
- Financial Wellness - 403(b) Retirement Plan with matching
- Continuing Education, Training and Advancement opportunities
Work Authorization/Security Clearance
All offers of employment made by Tempus Unlimited are contingent upon satisfactory background check results. Pre-employment background checks will be conducted on all candidates that are offered a position at the agency in compliance with program policy as well as state and federal regulations. From time to time, these checks may be conducted on current employees to ensure compliance with all state and federal regulations and contracts.
EEO Statement
Equal Employment Opportunity is a fundamental principle at Tempus Unlimited, Inc. where employment from recruiting through the end of employment is based upon professional capabilities and qualifications without discrimination because of race, color, religion, sex, age, sexual orientation, veteran status, national origin, disability or any other characteristic as established by law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.
Job Family: Specialist
Pay Type: Hourly
Hiring Rate: 23 USD
Travel Required: Yes
Compensation details: 23-23 Hourly Wage
PI0cb04d2a4e
Carries out activities related to utilization management, discharge planning, care coordination and referral to other levels of care.
Work with physicians, Social Workers with the interdisciplinary team to facilitate clinical pathways and achievement of desired treatment outcomes.
Promotes interdisciplinary collaboration and champion service excellence.
Works collaboratively to ensure patient needs are met and care delivery is coordinated across the continuum at the appropriate level of care.
Required Skills: 1.
Clinical expertise.
2.
Excellent interpersonal communication and negotiation skills.
3.
Strong analytical, data management and computer skills.
4.
Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
5.
Able to work with people of all social, economic, and cultural backgrounds.
6.
Flexible, open-minded and adaptable to change.
7.
Understanding of pre-acute and post-acute venues of care and community resources.
8.
Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
9.
Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients/families.
10.
Bilingual English/Spanish preferred, culturally sensitive.
11.
Ability to read and comprehend English at a level necessary to follow written and oral instructions and safety precautions.
Required Experience: A.
Work Experience: 1.
Three years of direct patient care experience in an acute care setting.
2.
Previous case management experience or related experience preferred.
B.
License/Registration/Certification: 1.
Current Texas RN License.
2.
Certified Case Manager (CCM) preferred.
C.
Education and Training: Bachelor's degree in Nursing required.
Master's degree in Nursing preferred.
Job Summary and Qualifications
The Registered Nurse (RN) CM is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management, and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team. The RN CM facilitates the progression and transition of care using established criteria and in conjunction with the multidisciplinary team. The RN CM will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization.
Your responsibilities will include:
- Guiding patients and families through program orientation, explaining the rehabilitation philosophy, Medicare and insurance benefits, discharge criteria, and patient rights
- Coordinating education for patients, families, and caregivers to encourage participation in treatment planning, goal discussions, and family conferences
- Developing and implementing individualized treatment plans that reflect the patient’s strengths, needs, and personal recovery goals
- Completing psychosocial assessments and discharge planning evaluations, clearly documenting findings and communicating needs across the care team
- Collaborating closely with the Rehab Program Director, Facility Case Management Director, and interdisciplinary team to ensure seamless, patient-centered care
- Promoting HCA Healthcare’s values of compassion, respect, and excellence through every patient and family interaction
What qualifications you will need:
Education & Experience:
- Associate Degree in Nursing or Nursing Diploma Required
- Bachelor’s Degree in Nursing Preferred
- 2+ years experience in case management OR 3+ years experience in clinical nursing Required
- InterQual experience Preferred
Licensure, Certifications, Training: Credential:
- Currently licensed as a Registered Nurse in the state(s) of practice according to law and regulation. Required
- Certification in Case Management Preferred
Benefits
Del Sol Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
- Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
- Wellbeing support, including free counseling and referral services
- Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
- Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
- Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
- Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
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"Nurses play a pivotal role and are the backbone of healthcare delivery. At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing."
Sammie Mosier, DHA, MA, BSN, NE-BC
Senior Vice President and Chief Nursing Executive, HCA Healthcare
Del Sol Medical Centeris a full service, acute-care hospital in east El Paso, Texas. We have a Level II trauma designation. This facility has 300+ patient beds. Our range of services include emergency care, cardiac care, women’s services, Level III NICU, rehabilitation, a bariatric clinic, and a Minimally Invasive Surgery Center. Del Sol Medical Center is part of Las Palmas Del Sol Healthcare. We are a leading healthcare provider for El Paso and the surrounding region that is part of HCA Healthcare.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
If this opportunity is your next step in your career path, we encourage you to apply for our Registered Nurse Case Manager opening. We review all applications. Qualified candidates will be contacted by a member of our team. We are interviewing, apply today!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Behavioral Health Utilization Management Medical Case Manager and help shape the future of healthcare where you'll be an integral part of our BHI ‐ BH Utilization Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework.
- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for authorization and notification of behavioral health services from health professionals, clinical facilities and ancillary providers. You will be responsible for prior authorizations, concurrent review and related processes. You will utilize CalOptima Health's medical criteria, policies and procedures to authorize referral requests from behavioral health professionals, clinical facilities and ancillary providers. You will directly interact with providers and facilities and serve as a resource for their needs. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
- 85% ‐ Utilization Management Services
- Participates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department.
- Reviews requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request.
- Responsible for mailing rendered decision notifications to the provider and member, as applicable.
- Screens inpatient and outpatient requests for the Medical Director's review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director's decision and documents follow‐up in the utilization management system.
- Completes the required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates.
- Contacts the health networks and/or CalOptima Health Customer Service regarding health network enrollments.
- Identifies and reports any complaints to the immediate supervisor utilizing the call tracking system or through verbal communication if the issue is of an urgent nature.
- Refers cases of possible over/under utilization to the Medical Director for proper reporting.
- Completes care coordination activities as related to Transition Care Management (TCM) activities.
- Reviews International Classification of Diseases (ICD‐10), Current Procedural Terminology (CPT‐4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and the existence of coverage specific to the line of business.
- 10% ‐ Administrative Support
- Assists manager with identifying areas of staff training needs and maintains current data resources.
- Complies with data tracking protocols.
- 5% ‐ Other
- Completes other projects and duties as assigned.
Do You Have What the Role Requires?
- Current California unrestricted license such as LCSW, LPCC, LMFT or RN and related required education PLUS 3 years of clinical experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
You'll Stand Out More If You Possess the Following:
- Utilization management reviewer experience.
- Managed care experience.
- Behavioral health clinical experience.
What the Regulatory Agencies Need You to Possess?
- Current California unrestricted license such as LCSW, LPCC, LMFT or RN.
Your Knowledge & Abilities to Bring to this Role:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem‐solve and possess project management skills.
- Work in a fast‐paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi‐program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations):
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‐to‐face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Ways We Are Here For You
- You'll enjoy competitive compensation for this role.
- Our current hiring range is: Pay Grade: 313 ‐ $90,820 ‐ $145,312 ($43.66 ‐ $69.8615).
- The final salary offered will be based on education, job‐related knowledge and experience, skills relevant to the role and internal equity among other factors.
- This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**)
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