Knowledge of community- based resources. * Must have excellent organizational skills and be able to ... CommunityCare is an equal opportunity at will employer and does not discriminate against any ...
58 Communitycare Community Outreach Worker Jobs Hiring Near You
Knowledge of community- based resources. * Must have excellent organizational skills and be able to ... CommunityCare is an equal opportunity at will employer and does not discriminate against any ...
Knowledge of community- based resources. * Must have excellent organizational skills and be able to ... CommunityCare is an equal opportunity at will employer and does not discriminate against any ...
Knowledge of community- based resources. * Must have excellent organizational skills and be able to ... CommunityCare is an equal opportunity at will employer and does not discriminate against any ...
Knowledge of community- based resources. * Must have excellent organizational skills and be able to ... CommunityCare is an equal opportunity at will employer and does not discriminate against any ...
Knowledge of community- based resources. * Must have excellent organizational skills and be able to ... CommunityCare is an equal opportunity at will employer and does not discriminate against any ...
... health workers, community organizations, and other healthcare professionals to address social ... CommunityCare is an equal opportunity at will employer and does not discriminate against any ...
... health workers, community organizations, and other healthcare professionals to address social ... CommunityCare is an equal opportunity at will employer and does not discriminate against any ...
Knowledge of community- based resources. * Must have excellent organizational skills and be able to ... CommunityCare is an equal opportunity at will employer and does not discriminate against any ...
Knowledge of community- based resources. * Must have excellent organizational skills and be able to ... CommunityCare is an equal opportunity at will employer and does not discriminate against any ...
Referral Coordinator
Austin, TX · On-site
$17.75 - $23.25/hr
... community healthcare center setting and for adhering to established timelines and departmental ... and CommUnityCare Policies and Procedures • Develops and maintain favorable internal ...
Referral Coordinator
Austin, TX · On-site
$17.75 - $23.25/hr
... community healthcare center setting and for adhering to established timelines and departmental ... and CommUnityCare Policies and Procedures • Develops and maintain favorable internal ...
Referral Coordinator
$17.75 - $23.25/hr
... community healthcare center setting and for adhering to established timelines and departmental ... and CommUnityCare Policies and Procedures • Develops and maintain favorable internal ...
Referral Coordinator
$17.75 - $23.25/hr
... community healthcare center setting and for adhering to established timelines and departmental ... and CommUnityCare Policies and Procedures • Develops and maintain favorable internal ...
Information Technology - Director of Product 130-7002
Tulsa, OK · On-site
$212K - $222K/yr
Oversee the Product Owner community across value streams by establishing product management ... Working knowledge of eligibility, claims, enrollment, care management, HEDIS, CMS regulatory ...
Information Technology - Director of Product 130-7002
Tulsa, OK · On-site
$212K - $222K/yr
Oversee the Product Owner community across value streams by establishing product management ... Working knowledge of eligibility, claims, enrollment, care management, HEDIS, CMS regulatory ...
Financial Eligibility Specialist
West, TX · On-site
Performs community outreach including in-home and agency visits. Financial Eligibility Specialist Job Requirements: * Experience: Previous experience and strong knowledge with Medicaid and/or Social ...
Financial Eligibility Specialist
West, TX · On-site
Performs community outreach including in-home and agency visits. Financial Eligibility Specialist Job Requirements: * Experience: Previous experience and strong knowledge with Medicaid and/or Social ...
Social Worker, Full-Time, Day Shift Community Care is hiring a Social Worker to be a part of our dedicated team providing care and service. The Social Worker position is full-time opportunity with ...
Social Worker, Full-Time, Day Shift Community Care is hiring a Social Worker to be a part of our dedicated team providing care and service. The Social Worker position is full-time opportunity with ...
Medical Assistant - Homeless Healthcare
Austin, TX · On-site
$17.50 - $22.50/hr
Collaborates with clinical teams, supervisory staff, and community partners to support outreach and engagement efforts for vulnerable patient populations. Participates in daily huddles ...
Medical Assistant - Homeless Healthcare
Austin, TX · On-site
$17.50 - $22.50/hr
Collaborates with clinical teams, supervisory staff, and community partners to support outreach and engagement efforts for vulnerable patient populations. Participates in daily huddles ...
Medical Assistant - Homeless Healthcare
Austin, TX · On-site
$17.50 - $22.50/hr
Collaborates with clinical teams, supervisory staff, and community partners to support outreach and engagement efforts for vulnerable patient populations. Participates in daily huddles ...
Medical Assistant - Homeless Healthcare
Austin, TX · On-site
$17.50 - $22.50/hr
Collaborates with clinical teams, supervisory staff, and community partners to support outreach and engagement efforts for vulnerable patient populations. Participates in daily huddles ...
RN Clinic Manager
West, TX · On-site
This is a full-time opportunity working out of our Vliet location. Clinic Manager Job Responsibilities: * Manages the daily operations of one of Community Care's Primary Care Clinics * Responsible ...
RN Clinic Manager
West, TX · On-site
This is a full-time opportunity working out of our Vliet location. Clinic Manager Job Responsibilities: * Manages the daily operations of one of Community Care's Primary Care Clinics * Responsible ...
Case Manager
Waukesha, WI · Hybrid
$20 - $25.75/hr
Community Care is hiring a Case Manager. This rewarding opportunity is perfect for someone who ... A minimum of three (3) years' experience working with seniors or adults with physical and/or ...
Case Manager
Waukesha, WI · Hybrid
$20 - $25.75/hr
Community Care is hiring a Case Manager. This rewarding opportunity is perfect for someone who ... A minimum of three (3) years' experience working with seniors or adults with physical and/or ...
Case Manager
Madison, WI · On-site
$20.25 - $26/hr
Community Care is hiring a Case Manager. This rewarding opportunity is perfect for someone who ... A minimum of three (3) years' experience working with seniors or adults with physical and/or ...
Case Manager
Madison, WI · On-site
$20.25 - $26/hr
Community Care is hiring a Case Manager. This rewarding opportunity is perfect for someone who ... A minimum of three (3) years' experience working with seniors or adults with physical and/or ...
Care Manager
West, TX · On-site
Community Care is hiring a Case Manager/Care Manager Day Shift for our Family Care Program in ... · Working collaboratively to develop, member centered care plans, provide on-going care ...
Care Manager
West, TX · On-site
Community Care is hiring a Case Manager/Care Manager Day Shift for our Family Care Program in ... · Working collaboratively to develop, member centered care plans, provide on-going care ...
Care Manager - Outagamie
Appleton, WI · On-site
Community Care is hiring a Case Manager/Care Manager to join our Family Care Program team. This ... A minimum of three (3) years' experience working with seniors or adults with physical and/or ...
Care Manager - Outagamie
Appleton, WI · On-site
Community Care is hiring a Case Manager/Care Manager to join our Family Care Program team. This ... A minimum of three (3) years' experience working with seniors or adults with physical and/or ...
Community Care is hiring a Case Manager/Care Manager Day Shift for our Family Care Program in ... · Working collaboratively to develop, member centered care plans, provide on-going care ...
Community Care is hiring a Case Manager/Care Manager Day Shift for our Family Care Program in ... · Working collaboratively to develop, member centered care plans, provide on-going care ...
RN Case Manager
Waukesha, WI · On-site
... the community. This is a full-time opportunity working out of our Waukesha location. *****$10,000 Sign On Bonus (External Hires)***** RN Case Manager Job Responsibilities: * Completes discipline ...
RN Case Manager
Waukesha, WI · On-site
... the community. This is a full-time opportunity working out of our Waukesha location. *****$10,000 Sign On Bonus (External Hires)***** RN Case Manager Job Responsibilities: * Completes discipline ...
Case Manager
Waukesha, WI · Hybrid
$20 - $25.75/hr
Community Care is hiring a Case Manager. This rewarding opportunity is perfect for someone who ... A minimum of three (3) years' experience working with seniors or adults with physical and/or ...
Case Manager
Waukesha, WI · Hybrid
$20 - $25.75/hr
Community Care is hiring a Case Manager. This rewarding opportunity is perfect for someone who ... A minimum of three (3) years' experience working with seniors or adults with physical and/or ...
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Full-time
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Job description
JOB SUMMARY:
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team.
KEY RESPONSIBILITIES:
QUALIFICATIONS:
EDUCATION/EXPERIENCE:
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team.
KEY RESPONSIBILITIES:
- Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute services when indicated.
- Determines medical necessity and appropriateness of services using clinical review criteria.
- Accurately documents all review determinations and contacts providers and members according to established timeframes.
- Appropriately identifies and refers cases that do not meet established clinical criteria to the Medical Director.
- Appropriately identifies and refers quality issues to Medical Management leadership.
- Appropriately identifies potential cases for Care Management programs.
- Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum.
- Performs accurate data entry.
- Communicates appropriate information to other staff members as necessary/required.
- Participates in continuing education initiatives.
- Collaborates with other departments as needed.
- Performs other duties as assigned.
QUALIFICATIONS:
- Knowledge of managed care and associated group benefit plans.
- Possess strong oral and written communication skills.
- Ability to reason logically and to use good judgment when interpreting materials or situations.
- Knowledge of community- based resources.
- Must have excellent organizational skills and be able to perform multiple tasks.
- Proficient in Microsoft applications.
- Excellent time management and documentation skills.
- Successful completion of Health Care Sanctions background check.
EDUCATION/EXPERIENCE:
- Graduation from accredited School of Nursing.
- Current, active, unrestrictive license to practice as a Registered Nurse in the State of Oklahoma.
- Three years of acute care experience preferred.
- Two years of experience working with population health preferred.
- Previous discharge planning or case management experience preferred.
- Managed care experience a plus.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin