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60 Caloptima Managed Care Case Manager Jobs Hiring Near You

N2S Global

Healthcare case manager

Topeka, KS · Remote

Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination ...

BrightSpring

Foster Care Case Manager

Louisville, KY

$19.23/hr

If your passion is to ensure quality care to help our clients live their best life we encourage you ... Maintains relationships with standard referral sources and payer case managers. Contacts identified ...

US Tech Solutions

Healthcare case manager

Topeka, KS · Remote

Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination ...

BrightSpring

Foster Care Case Manager

Prestonsburg, KY

$19.23/hr

If your passion is to ensure quality care to help our clients live their best life we encourage you ... Maintains relationships with standard referral sources and payer case managers. Contacts identified ...

Sevita Health

Foster Care Case Manager

Willingboro, NJ · On-site

$40K - $48K/yr

Case Manager Office located in Mt. Laurel Service areas (Burlington, Gloucester, Mercer counties ... Coordinate care with team members to ensure youth receive high-quality care * Exceptional ...

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Healthcare case manager

N2S Global

Topeka, KS • Remote

Contractor

Re-posted 21 days ago

Job description


Position Summary:
This will be a full-time telework role in Kansas, however, will require 50-75% travel for face-to-face visits in assigned area once COVID restrictions are lifted. Schedule is Monday-Friday, standard business hours. Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Healthcare. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and
education for members through the use of care management tools and resources.
Responsibilities:
- Through the use of care management tools and information/data review, conducts comprehensive
evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or
meeting needs by evaluating member's benefit plan and available internal and external programs/services.
- Identifies high risk factors and service needs that may impact member outcomes and care planning
components with appropriate referral to clinical case management or crisis intervention as appropriate
- Coordinates and implements assigned care plan activities and monitors care plan progress.
Enhancement of Medical Appropriateness and Quality of Care:
- Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health
programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to
obtain multidisciplinary review in order to achieve optimal outcomes.
- Identifies and escalates quality of care issues through established channels.
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
Experience:
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and
promote lifestyle/behavior changes to achieve optimum level of health.
- Provides coaching, information and support to empower the member to make ongoing independent
medical and/or healthy lifestyle choices.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and
accreditation guidelines and company policies and procedures
Education:
behavioral health, social services, or human services field.
Case Management
 

About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.

 

US Tech Solutions is an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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