Professional Case Management Address 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.

The RN Case Manager manages a continuum of care from pre-admission through post-discharge for assigned patients.  Assure that patients and families proceed efficiently throughout the course of hospitalization.  Focus of the position is the appropriate utilization of hospital services, maximizing reimbursement from all third party payors, and education of medical/hospital staff about healthcare options.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit or follow us on Facebook, Twitter, or Instagram.

• Broad knowledge of disease process, pathophysiology and treatment plan
• Strong assessment skills with high-developed critical thinking skills and analysis abilities
• Good understanding of psychosocial and cognitive assessment
• Familiarity with discharge planning process and care options

Required:

• Maintain an active California RN license.
• Computer proficiency. 

Preferred:

• Previous experience in case management preferred.
• Minimum of one (1) year acute hospital nursing experience.
• Organizational abilities and familiarity with medical assessment. Understands treatment plans and healthcare delivery system. 

POSITION SUMMARY AND RESPONSIBILITIES

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.

EDUCATION/EXPERIENCE

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.

LICENSURE

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

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

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary
This is telework position with up to 50-75% travel in designated region of Illinois. Standard working hours can be anywhere within 8am - 9pm as needed to meet business needs. This Care Manager BH role requires working until 9pm for two (2) days a week. Care Manager BH coordinates all case management activities with members to evaluate medical needs and to facilitate the overall wellness of members. Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration. Instructs programs and procedures in compliance with network management and clinical coverage policies.

Essential Duties and Responsibilities:

• Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans

• Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues.

• Handles reviews of prior claims to address potential impact on current case management and eligibility.

• Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality.

• Ensures case management processes follow organization and regulatory requirements.

• Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions.

• Coaches and trains junior colleagues in techniques, processes, and responsibilities.

• Primarily works with members enrolled into Pathways to Success Program for intensive care coordination support.

Required Qualifications

• Clinical licensure

• Minimum two years experience working with children living with special needs or children in foster care

• Willing and able to travel up to 50-75% of their time to meet members face to face within one hour of their location

• Reliable transportation required; mileage is reimbursed per company expense reimbursement policy

• Willing and able to work until 9:00pm two (2) days a week

Preferred Qualifications

Managed Care experience

Case Management experience

Education

Masters Degree in Social Work or any related field

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit  anticipate the application window for this opening will close on: 03/31/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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.

General Summary of Position

Serves as a member of the Case Management Team and applies RN clinical expertise and medical appropriateness to care coordination and discharge planning. Facilitates the delivery of quality cost effective patient-centered care from pre-admission through post-discharge timeframe. Ensures the care is designed to meet individualized patient outcomes. Monitors the care and services delivered to selected patient populations during the acute hospital stay promotes effective case management and utilization of resources and works to achieve optimal clinical and resource outcomes for the acute and post-hospital phases of care.

Primary Duties and Responsibilities

• Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
• Collaborates with the multidisciplinary health care team to develop and coordinate the plan of care.
• Communicates with patient family and/or significant other health care team external case manager community resources and facility to address appropriate issues and patient/family goals.
• Demonstrates the ability to develop a plan of care that addresses needs across the continuum; have an intervention for problems identified; develop long- and short-term goals with specific time frames for resolution; identify specific services to be provided in the care plan; include the family/care-giver in the plan of care; and show life planning contingencies such as power of attorney and/or advance directives.
• Evaluates and documents the patient's response to the plan of care and achievement of outcomes. Makes recommendations for modifications to the plan of care as indicated. Adheres to all policies and procedures regarding documentation and confidentiality of information.
• Maintains knowledge of regulatory agencies' requirements necessary criteria for admission to various care settings and Medicare's/Medicaid's reimbursement methods for different levels of care.
• Manages a caseload of patients. Identifies essential resources needed to implement the plan of care.
• Manages own professional growth in the area of managed care care management other health care financial trends clinical practice and research.
• Manages patient care according to multidisciplinary plan of care and/or managed care contracts by directing decision making and identifying and managing barriers that impact on patient care outcomes.
• Participates in Performance and Service Improvement teams. Assists in program evaluation through customer service surveys LOS data analysis charge/discharge data comparison to state averages and best practice/benchmark data.
• Performs a comprehensive assessment in collaboration with interdisciplinary team to identify patient-specific problems and needs related to diagnosis treatment including psychosocial and financial concerns as well as medical.

Minimal Qualifications
Education

• Associate's degree in Nursing (ADN) required
• Bachelor's degree in Nursing (BSN) preferred

Experience

• Minimum of 2 years clinical experience in an acute care hospital setting required
• 1-2 years case management experience preferred

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure in the District of Columbia or Maryland depending on work location required
• CCM - Certified Case Manager preferred

Knowledge Skills and Abilities

• Ability to use computer to enter and retrieve data.
• Working knowledge of Microsoft Word Excel and PowerPoint applications.
• Effective verbal and written communication skills.
• Must be able to run and analyze departmental productivity reports.
• Excellent interpersonal skills required.

Who we are

Founded in 1999 and headquartered in Central Ohio, we’re a privately owned , independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®.

We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.

About the role

The Transplant Nurse (PCG) facilitates care coordination for a member with the potential for a transplant, including hematologic malignancies and end stage disease processes. The position requires a multidisciplinary, collaborative approach to manage the complexity, financial impact , frequent resource utilization and variable acuity across the transplant continuum. Management begins at referral and follows through pre-transplant care, evaluation , and the transplant phase to post-transplant case closure.

Location : This position is located at our Dublin, OH campus with hybrid flexibility.

What you’ll do (Essential Responsibilities)

Identify and assess members with the potential for solid organ or bone marrow transplant, end stage renal disease, and hematologic malignancies.

Apply the nursing process when actively case managing transplant members.

Utilize well-developed critical thinking and interpersonal skills to problem-solve and make knowledgeable recommendations for needed actions.

Document all activities specific to members, caregivers, providers, facilities and clients in appropriate database.

Maintain a collaborative relationship with members’ health care teams by communicating information, responding to requests, building rapport , and participating in team problem-solving methods.

Serve as member and provider advocate by educating and guiding through the transplant process.

Provide benefit and health information to each member so they are able to make informed health decisions.

Maintain a working knowledge of all policies and procedures related to Clinical Operations.

Work closely with and provide updates to internal client executives and employer contacts for transplant patients.  

Maintain a working knowledge of employer health benefit plans and know where to access benefit information.

Be a clinical resource for all Quantum Health work teams.

Maintain working knowledge of Transplant Vendor contracts, single case rate agreements, access agreements, and negotiated agreements as required by client plan design. 

Assist members and clients with wellness activities, enhanced benefits, behavioral incentives

Be a transplant clinical resource for all Quantum Health work groups.

Work closely with and provide updates to internal client executives and employer contacts for transplant patients.

Maintain contact with the QH clinical staff for transfer of cases when appropriate.

All other duties as assigned.

What you’ll bring (Qualifications)

Licensure : Current and active license as a Registered Nurse in the state of Ohio, BSN preferred

Experience: Minimum of two years clinical experience with direct patient care required

Certification in Case Management preferred within 2 years of hire

Outstanding computer skills including Microsoft applications

Excellent critical thinking skills

Possess excellent verbal and written communication skills

Possess excellent time management skills

Demonstrate ability to work autonomously

Solid organ or bone marrow transplant experience desired

Effective communication skills, both verbal and written.

A high degree of personal accountability and trustworthiness, a commitment to working within Quantum Health’s policies, values and ethics, and to protecting the sensitive data entrusted to us.

#LI-HW1 #LI-Hybrid #LI-Remote

• Compensation: Competitive base and incentive compensation
• Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
• Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
  
• Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
• Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
• Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.
• Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!

What you should know

• Internal Associates: Already a Healthcare Warrior? Apply internally through Jobvite.
• Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background Check.
• Diversity, Equity and Inclusion: Quantum Health welcomes everyone. We value our diverse team and suppliers, we’re committed to empowering our ERGs, and we’re proud to be an equal opportunity employer .
• Tobacco-Free Campus: To further enable the health and wellbeing of our associates and community, Quantum Health maintains a tobacco-free environment. The use of all types of tobacco products is prohibited in all company facilities and on all company grounds.
• Compensation Ranges: Compensation details published by job boards are estimates and not verified by Quantum Health. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate’s unique combination of experience and qualifications related to the position.
• Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.
• Agencies: Quantum Health does not accept unsolicited resumes or outreach from third-parties. Absent a signed MSA and request/approval from Talent Acquisition to submit candidates for a specific requisition, we will not approve payment to any third party.

Reasonable Accommodation: Should you require reasonable accommodation(s) to participate in the application/interview/selection process, or in order to complete the essential duties of the position upon acceptance of a job offer, click here to submit a recruitment accommodation request.

Recruiting Scams: Unfortunately, scams targeting job seekers are common. To protect our candidates, we want to remind you that authorized representatives of Quantum Health will only contact you from an email address ending in @ . Quantum Health will never ask for personally identifiable information such as Date of Birth (DOB), Social Security Number (SSN), banking/direct/tax details, etc. via email or any other non-secure system, nor will we instruct you to make any purchases related to your employment. If you believe you’ve encountered a recruiting scam, report it to the Federal Trade Commission and your state’s Attorney General .

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

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

Pay Range

Description of Benefits

​
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.

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

Required Experience/Skills:

• Diploma, Associate, or Bachelor Degree in Nursing

• A minimum of one year of nursing experience in Home Health

• OASIS Proficiency

• Home Care Home Base experience

• 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

Pay Range

Description of Benefits

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.

$5,000 Sign-on Bonus for External Candidates

This position is open to candidates who live in DC, MD, or VA

This is a field-based position in the greater Washington D.C. area.

Expect to spend about 50-75% of your time in the field visiting our members in their homes or in long-term care facilities in the local area.

You'll need to be flexible, adaptable and, above all, patient in all types of situations.

Standard Hours: Monday - Friday normal daytime business hours (no on-call, no weekends and no holidays required).

• Assess, plan and implement care management interventions that are individualized for each member and directed toward the most appropriate, least restrictive level of care
• Develop and implement care plan interventions throughout the continuum of care as a single point of contact
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team
• Identify appropriate interventions and resources to meet gaps (e.g., psychosocial, transportation, long-term care) based on specific consumer needs from both the health care and psychosocial / socioeconomic dimensions of care
• Document the plan of care in appropriate EHR systems and enter data per specified
• Maintain consumer engagement by establishing rapport, demonstrating empathy, and building a trusting relationship
• Collaborate with primary providers or multidisciplinary team to align or integrate goals to plan of care and drive consistent coordination of care
• Provide ongoing support for advanced care planning
• Reassess plan of care at appropriate intervals based on initial objectives, significant change of condition, or achievement of goals
• Understand and operate effectively/efficiently within legal/regulatory requirements
• Utilize evidence-based guidelines (e.g., medical necessity guidelines, practice standard)
• Make outbound calls and receive inbound calls to assess members' current health status
• Identify gaps or barriers in treatment plans
• Provide member education to assist with self-management
• Make referrals to outside sources
• Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction
• Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels

Required Qualifications:

• Current unrestricted Registered Nurse license in Washington D.C., or the ability to obtain within 90 days of hire date
• Certified in Basic Life Support
• 2+ years of experience working with MS Word, Excel and Outlook
• 1+ years of experience in post - acute care, such as long-term care
• 1+ years of clinical case management experience
• 1+ years of experience with using an Electronic Medical Record
• Valid Driver's License and access to reliable transportation
• Ability to work in a field-based capacity in Washington, D.C.
• Reside within 50 miles of Washington, DC

• Certified Case Management (CCM)
• 1+ years of experience working with the geriatric population
• 1+ years of LTSS (Long Term Services and Supports)
• 1+ years of HCBS (Home and Community Based Services) experience
• Field based experience going into members' homes
• Experience creating care plans
• Case Management experience
• Background in managing populations with complex medical or behavioral needs

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

City of Kirkland

$105,122.98 - $122,830.27 Annually

Kirkland, WA

Full-Time

202100752

Fire - Mobile Integrated Health Program

03/04/2026

Exempt

AFSCME

The City of Kirkland's Fire Department is seeking to hire a Case Worker I for the Mobile Integrated Health (MIH) division!

Why Kirkland?

Ranked as one of the most livable cities in America, Kirkland is an attractive and inviting place to live, work, and visit. We have big city vision while maintaining a small-town, community feel. If you are a candidate with the desire to join an organization looking to innovate into the future, the City of Kirkland is the place for you!

If you ask our employees why they love where they work, they will tell you about the great people, work environment, supportive leadership and City Council, and fearless innovation.

We also invest in you!

Competitive Wages: We strive to maintain competitive compensation packages and work to provide wages that meet the knowledge, skills, and abilities of our employees.

Awesome benefits: The City offers benefits that are unmatched by most other employers. Please click on the benefits tab above to view more details.

Childcare Programs: To help address the challenge of reliable childcare, the City of Kirkland has agreements with two local childcare providers that offer discounted rates for our employees at 10 locations within 20 miles of Kirkland. Learn more!

Training and Career Development: The City of Kirkland believes in developing it's employees. You will have access to training opportunities designed for career development and advancement based on your position, skills, and interests.

Job Summary

• Follows up with clients and makes in-home visits to meet, interview, and assess residents after an initial encounter, referral, or response at the request of Police, Fire, or other authorized entities. Conducts biopsychosocial assessments when needed.
• Serves as one of the Department's subject matter experts on social and human services.
• Establishes and maintains relationships with outside agencies who are partners in the effort to guide 911 callers towards appropriate medical and social services.
• Participates in the development of the Department's performance metrics, tracking, and referrals related to the Mobile Integrated Health team.
• Promotes best practices in treatment approaches, support systems, and interventions through trainings that support clinical competency, culturally relevant practices, and use of appropriate technologies.
• Works with adult family homes, assisted living facilities, group homes, skilled nursing facilities and other care facilities to improve client outcomes.
• Works with City personnel who encounter and refer vulnerable individuals in need of assistance in their care, safety, mental or physical health issues.
• Keeps timely and organized progress notes on individuals enrolled for services.
• Uses clinical experience and expertise to inform evaluation, case management, coaching, and advocacy decisions with clients referred to MIH.
• Monitors and finds solutions for callers who are deemed "high users" of the 911 system.
• Provides proactive leadership to foster understanding and teamwork in the area of community response.
• Fosters a positive and supportive work environment; promotes diversity, equity, inclusion, and belonging in the workplace, contributing to an environment of respectful living and working in a multicultural society.
• Completes and maintains training requirements as established by the Department.

• Performs functions as assigned in the City's emergency response plan in the event of an emergency.

• Skilled in tracking client progress outcomes and use of data systems for case management and outcome tracking.
• Knowledge of HIPPA and RCW's and other laws related to the maintenance, retention, and confidentiality of patient records.
• Skilled in applying a trauma-informed care approach with people of diverse backgrounds.
• Knowledge of the principles of behavior and motivation.
• Knowledge of community health, housing, financial, and behavioral health resources and criteria for providing services.
• Knowledge of local, state, and federal social service programs and eligibility criteria, including Veteran-specific programs, Medicare and Medicaid.
• Knowledge of Microsoft Office Suite (including Word, Excel, Outlook) or similar programs.
• Knowledge of business letter writing, email communications, and report preparation.
• Understanding of regional programs and initiatives, including partnerships and inter-agency cooperation with other public and private agencies in the region such as MIH in King County and the Regional Crisis Response (RCR) Agency.
• Ability to exercise good judgment and assume responsibility for decisions, consequences, and results having an impact on people, the organization, and quality of service within the assigned area.
• Ability to effectively handle confidential, delicate, and sensitive issues, using tact and diplomacy.
• Excellent interpersonal skills, including the ability to effectively communicate and build and maintain effective team relationships with employees, public officials, and diverse populations.
• Ability to communicate clearly and concisely, both verbally and in writing.
• Ability to maintain and project a calm, informational, and persuasive demeanor in stressful situations.
• Ability to establish and maintain productive professional relationships with City of Kirkland staff, MIH program partners, RCR Agency affiliates, and other community partners.
• Ability to meet the expectations and requirements of internal and external stakeholders; obtain first-hand information and use it for improvements in services; act with community in mind; establish and maintain effective relationships and gain trust and respect.
• Value Diversity, Equity, Inclusion, and Belonging. Understand and support equity and inclusion in policies and practices; work effectively with people from diverse backgrounds, perspectives and lived experience; inspire and encourage fair treatment.

Minimum Qualifications:

• Education: Master's degree in social work, sociology, psychology, human development, or other related field or Associate's license as a social worker, mental health counselor, or marriage and family therapist as defined by WAC 246-809.
• Experience: 1 year of paid experience in a health care setting, including public health or behavioral health.
• Or: In place of the above requirements, the incumbent may possess any combination of relevant education and experience which would demonstrate the individual's knowledge, skill, and ability to proficiently perform the essential duties and responsibilities listed above.

• Must have a valid Washington State Driver's license with 30 days of hire, and ability to remain insurable under the City's insurance to operate motor vehicles.
• Experience working with public safety entities preferred.

Physical Demands and Working Environment:
Must be physically capable of effectively using and operating various items of office related equipment, such as, but not limited to, a personal computer, tablet computer, calculator, copier, scanner and fax machine. Must be able to safely operate a city vehicle.
Must be physically capable of lifting, walking, moving, carrying, climbing, bending, kneeling, crawling, reaching, handling, sitting, standing, pushing, and pulling. Will navigate rugged terrains and unsanitary public places, homes, and shelters. Ability to carry, don, and doff personal and safety equipment during community response, including N95 mask and eye protection.
Work involves contact with individuals and clients who may be experiencing housing insecurity. The incumbent may be exposed to repeated emotionally disturbing situations, high-stress dynamic situations, hostile and/or aggressive behaviors, which could present a personal risk of harm. Work may require visits to jails and out-of-town locations, emergency rooms, and other medical facilities. May include exposure to bloodborne pathogens or other potentially infectious material (OPIM).
This position encounters foot hazards as defined by the WAC, which may include any of the following: falling objects, rolling objects, piercing/cutting injuries, or electrical hazards.

Selection Process

Position requires a resume and cover letter for consideration of application. Please note how you meet minimum qualifications within the cover letter. Applicants who are selected for next steps in the hiring process will be invited by phone or e-mail. Candidates are encouraged to apply at the earliest possible date as screening, interviewing, and hiring decisions will be made through the recruitment period, until such time as the vacancy is filled.

The City of Kirkland is a welcoming community where every person can thrive and grow. We value diversity, inclusion, belonging, and work together to support our community. We do this by solving problems, focusing on the customer, and respecting all people who come into the City whether to visit, live, or work. As an Equal Opportunity Employer, we are committed to creating a workforce that does not discriminate on the basis of race, sex, age, color, sexual orientation, religion, national origin, marital status, genetic information, veteran status, disability, or any other basis prohibited by federal, state or local law. We encourage qualified applicants of all backgrounds and identities to apply to our job postings. Persons with a disability who need reasonable accommodations in the application or testing process, or those needing this announcement in an alternative format, may call or Telecommunications Device for the Deaf 711.

Brandywine Counseling & Community Services (BCCS) is seeking a dedicated Case Manager to support individuals transitioning from incarceration back into the community. If you are passionate about recovery, second chances, and reducing recidivism through meaningful support, this role offers the opportunity to make a lasting impact.

About BCCS

Since 1985, BCCS has been a trusted provider of substance use and behavioral health treatment. We enhance quality of life through Education, Advocacy, Prevention, Early Intervention, and Treatment Services — promoting hope and empowerment for individuals and families affected by mental illness, substance use, HIV, and co-occurring conditions. We promote hope and empowerment to persons and families touched by mental illness, substance abuse, HIV and multiple occurring diagnoses, and their related challenges.

What You'll Do:

• Provide intensive, recovery-oriented case management services to justice-involved individuals following release from incarceration
• Support successful community reintegration by addressing criminogenic needs, substance use recovery, mental health stability, and social determinants of health. Services are delivered using evidence-based and client-centered approaches that promote self-sufficiency, resilience, and long-term recovery
• Provide comprehensive post-release case management services to returning citizens transitioning from incarceration into the community
• Conduct strength-based assessments and develop individualized, goal-oriented service plans in collaboration with clients
• Coordinate and monitor referrals to SUD aftercare treatment, MAT providers, mental health services, housing, employment, medical care, and other supportive services
• Utilize Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) techniques to support behavioral change and treatment engagement
• Implement Solution-Focused Therapy (SFT) principles, emphasizing future-oriented goals, collaborative planning, and identification of client strengths and past successes
• Support a recovery-oriented approach, assisting clients in defining recovery as a personal journey of healing and transformation rather than symptom management alone
• Promote client self-empowerment, resilience, and accountability while reducing barriers to successful reentry
• Maintain regular contact with clients through in-person meetings, phone calls, and community visits as required
• Collaborate with Delaware Community Correction officers, treatment providers, and community partners to ensure continuity of care
• Maintain accurate, timely, and compliant documentation
• Participate in team meetings, supervision, training, and quality improvement activities

Qualifications for this position are:

• REQUIRED: Associate Degree with CADC/CAADC Certification OR
• REQUIRED: Bachelor’s Degree (if not CADC/CAADC Certified)
• REQUIRED: 1 Year Experience in Substance Abuse/Addiction and/or Mental Health
• PREFERRED: 1 Year Experience with Community Resources and Co-Occurring Disorders

Pay:

• Starting at $23/hour
• Commensurate with experience, education, and certification!

Schedule:

• Monday - Friday
• 7:00 a.m. - 3:00 p.m. or 8:00 a.m. - 4:00 p.m.

The compensation package for this position includes:

• Group medical, dental, and vision coverage with low employee costs
• 34 paid days off annually
• Tuition reimbursement
• A retirement plan with a company match of up to 4%!
• Brandywine Counseling is a qualified employer for Public Service Loan Forgiveness (PSLF)
• No weekends!
• Opportunity for advancement

Do you have the career opportunities as an RN Case Manager Lead you want with your current employer? We have an exciting opportunity for you to join HCA Florida Osceola Hospital which is part of the nation's leading provider of healthcare services, HCA Healthcare.

HCA Florida Osceola Hospital offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
  
• Family support through fertility and family building benefits with Progyny and adoption assistance.
  
• Referral services for child, elder and pet care, home and auto repair, event planning and more
  
• Consumer discounts through Abenity and Consumer Discounts
  
• Retirement readiness, rollover assistance services and preferred banking partnerships
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
• Colleague recognition program
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as an RN Case Manager Lead where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

The primary purpose of the Lead Case Manager is to ensure that primary operations of the Case Management/Utilization Review Department function efficiently. This position maintains a caseload or equivalent assignment as volume dictates while providing a first line resource to Case Managers, Utilization Review, and Medical Social Workers. This position routinely dialogs with the Manager and/or Director to ensure seamless front line communication.

• Performs a comprehensive assessment of psychosocial and medical needs of assigned patients, in collaboration with the assigned Treatment Coordinator.
• Acts as coordinator of patient/family/caregiver education and monitors documentation of education by team members. Promotes participation of the patient/family/caregiver in team discussions related to plans, goals and status through Family Conferences and other interactions.
• Ensures implementation of an individual treatment plan that supports patient strengths, abilities, needs, and preferences. Directs activities of the Patient Care Conference. Coordinates team activities in the implementation of patient treatment plan and re-assesses treatment plan after a change in patient condition. Facilitates the involvement of the patient throughout the rehabilitation process.
• Documents findings of the Discharge Planning Evaluation (DPE) and psychosocial assessments. Communicates information of social, financial or discharge needs and preferences of the patient/family/caregiver. Uses financial information available in decision making about the provision of services for the patient.
• Ensures communication with external and internal sources. Interacts with patients, team members and other stakeholders.
• Provides thorough verbal and/or printed information to help patients/families/caregivers make informed decisions about post-acute care options, while addressing goals of care and treatment preferences. Provides printed tools explaining how to access additional details from website.
• Adheres to hospital policy when making post discharge referrals, documenting the process in the patient record. Provides Patient Choice letter and full list of post-acute providers in patient's designated area.
• Provides or makes appropriate referral for individual, family, group, or sexual counseling as needed. Makes appropriate peer support referrals within the community prior to discharge.
• Facilitates discharge and arrangement of follow-up services. Facilitates implementation of discharge/transition recommendations. Identifies and utilizes appropriate community resources to meet patient discharge and continuity of care needs.
• Participates in quality improvement activities. Assists in the collection and analysis of utilization data, identification of improvement areas, and improvement plan implementation.
• Assumes accountability for promoting consistent, positive patient interactions that advance the agenda of unparalleled patient service.
• Maintains a patient-first philosophy and engages in service recovery when necessary.
• Supports the development and implementation of strategies to elevate the patient experience.
• Performs other duties as assigned.
• Practices and adheres to the Code of Conduct and Mission and Value Statement.

• Associate Degree in Nursing or RN Diploma Required

• Bachelor's Degree in Nursing Preferred
• 3 years experience Required Years of Experience

HCA Florida Osceola Hospital is a 404-bed tertiary care hospital. We are accredited by the Joint Commission and are a Level II Trauma Center. We are a teaching hospital in collaboration with UCF College of Medicine. Our hospital is conveniently and centrally located in the Heart of Kissimmee. We are only minutes from Orlando, St. Cloud, Celebration, and Poinciana. We are committed to enhancing the standard of healthcare by providing services including Emergency Care, Trauma Care, Pediatric ER, Heart & Vascular Institute, and Comprehensive Stroke Center. Other services include The Baby Suites Maternity Care, Neonatal Intensive Care Unit Level II, Women's Services, Behavioral Health, Orthopedics & Spine, and a Graduate Medical Education Program. We expand our care to the community with our freestanding Emergency Department at Hunter's Creek ER.

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 you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our RN Case Manager Lead opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and 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.