Job Board | Manager Case Management

RN Case Manager

CareFirst BlueCross BlueShield

Your future is bright at CareFirst.

CareFirst BlueCross BlueShield is the largest health care insurer in the Mid-Atlantic region. Every day, we help people make decisions that will positively impact their lives today and into the future. Take your experience to the next level in a company that is financially strong and nationally respected as a Case Manager at one of our DC or MD locations.

We currently have the following Case Manager opportunities:

-Pediatrics

-Oncology

-High Risk Pregnancy

-Complex Medical Illnesses

-Palliative Care/Hospice

-Trauma / Rehabilitation

Responsibilities include care coordination and making the required health care connection, while providing the necessary resources to prevent fragmentation of care, to encourage self empowerment, achieve transparency that will promote optimal outcomes.

Qualifications:

-A current RN license in DC, MD, or VA and a minimum of 3 years of clinical experience in medical-surgical, community/home health care, case management, and equivalent experience.

-Experience reviewing patient medical care and services, strong analytical and statistical abilities, and familiarity with a PC/mainframe environment.

-BSN, OCN or CCM and prior experience with home care and case management with an understanding of managed care is preferred.

We offer competitive salaries and excellent benefits. For complete job descriptions and/ or to apply online, please visit our website www.carefirst.com and search our jobs database.

CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association.

® Registered trademark of the Blue Cross and Blue Shield Association.

® Registered trademark of CareFirst of Maryland, Inc.

| Posted on January 22, 2012 |

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RN, Telephonic Case Manager - Workers Compensation Hunt Valley

Coventry Health

GENERAL SUMMARY

Responsible for telephonically assessing, planning, implementing and coordinating all case management activities associated with an injured employee to evaluate the medical and disability needs of an injured worker and facilitate the patient's appropriate and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel.

ESSENTIAL RESPONSIBILITIES

-- Works telephonically with workers' compensation patients, employers, providers, and claims adjusters to coordinate and assure proper delivery and oversight of medical and disability services.

-- Performs pre-certification process for prescribed treatment by gathering relevant data and information through clinical interviews with the injured employee, provider(s), and the employer.

-- Evaluates and coordinates medical and rehabilitative services using cost containment strategies. Plans a proactive course of action to address issues presented to enhance the injured employee's short- and long-term outcomes.

-- Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care. Works as an advocate to promote the injured employee's best interest, addressing treatment alternatives, coordination of quality, cost effective health care and rehabilitative services.

-- Assists the injured employee by providing medical and disability education and coordinating on-site job analysis, work conditioning, functional capacities, and ergonomic evaluations.

-- Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee's functional capacity to ensure the injured employee's safe and timely return to work.

-- Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches, over or under utilization, inappropriate care, effective treatment, permanent or temporary loss of function, failed or premature return to work, and non-compliance.

-- Adheres to all appropriate privacy, security and confidentiality policies and procedures.

-- Performs other duties as assigned.

Requirements

JOB SPECIFICATIONS

-- RN with current state license required.

-- Previous (3 or more years) general clinical experience required.

-- Bachelor's degree or equivalent experience preferred.

-- CCM, CRRN, COHN, or CDMS eligibility or current certification required. These designations are required where dictated by state law.

-- Previous workers compensation, case management, utilization review or managed care experience preferred.

-- Strong problem solving and analytical skills.

-- Demonstrated communication, organizational, and interpersonal skills.

apply online to www.cvty.com go to careers req # 165720

Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team".

Contact

Anne Biggs, Regional Recruiter

Coventry Workers' Comp Services

Solutions to Restore Health and Productivity

Office: 972 807 4186

Fax : (800) 698-0135

www.coventrywcs.com

| Posted on January 17, 2012 |

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Full Time Medical Case Manager

Great Baden Medical Services, Inc.

Full Time Medical Case Manager

- RN or Social Worker (L.C. S. W.) with current Maryland License

- Strong team player with excellent organizational skills

- Three to five years experience as a registered nurse or case

manager in an outpatient/community chronic disease management health setting

- Knowledge of community health and human services desired

- Knowledge of Ryan White program highly desired

- Proficient in Windows Microsoft Office Suite at a minimum

Contact

Lisa Connors can be reached at (301) 599-0460 ext. 3331.

Resume can be faxed to

Lisa Connors at (301) 599-0463.

| Posted on December 30, 2011 |

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MANAGER, QUALITY IMPROVEMENT & UTILIZATION REVIEW

Qualis Health

Qualis Health, a nationally-recognized healthcare Quality Improvement Organization, is pursuing an opportunity with the District of Columbia Department of Health Care Finance to conduct utilization reviews and quality improvement activities for approximately 73,000 of the District's Fee-For-Service Medicaid Program participants.

In this key role, you'd develop, implement, and lead a quality improvement and management plan and a utilization and quality review program, both aimed at improving safeguards against unnecessary or inappropriate use of

Medicaid services; ensuring provision of appropriate care through prospective, concurrent and retrospective reviews of services; medical records review; validation of the appropriateness of requested services; improved data gathering and reporting; and the identification of fraud, waste, abuse, and other violations. You'll possess a Master's degree in

healthcare administration, nursing, business administration, or a related field and at least three years of Medicaid-specific utilization review and quality improvement experience OR a Bachelor's degree and five years of such experience. To apply, email your resume to mycareer@qualishealth.org<mailto:mycareer@qualishealth.org> EEO/AA M/F/D/V

Contact

For more information, please contact

Kevin Sheets, SPHR

HR Consultant - Employment

Qualis Health

PO Box 33400

Seattle, WA 98133-0400

T (206) 288-2323

F (206) 361-5400

| Posted on November 6, 2011 |

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