Top 9559 Case Manager Exempt Jobs

Utilization Management Clinician I
Community Health Plan of Washington —Seattle, WA
- $35.92 - $55.67 an hour
- Full-time
- Mid-level
- Analysis skills
- Critical & Intensive Care
- Paid jury duty
- Health savings account
Quick Apply
Utilization Review Case Manager
AMFM Healthcare —San Juan Capistrano, CA
- $30 - $35 an hour
- Full-time
- Background check
- 18 years or older
- Google Workspace
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Registered Nurse Care Manager - Clinical Diabetes Educator; $30,000 Sign On, $15,000 Relocation, and Retention Bonus eligible
Yukon-Kuskokwim Health Corporation —Bethel, AK
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- RN License
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Family Services Inc. —Town of Dover, NY
- $55,000 - $75,000 a year
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- Licensed Clinical Social Worker
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Hospice Registered Nurse Case Manager
HUDSON VALLEY HOSPICE INC —Kingston, NY
- $80,000 - $90,000 a year
- Full-time
- Bilingual
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Clinician
Shalom House —Portland, ME
- $35.40 an hour
- Full-time
- Clean driving record
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- Disability insurance
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Children's Community Case Manager
Aroostook Mental Health Services, Inc. —Houlton, ME
- $42,609 - $51,130 a year
- Full-time
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- Driver's License
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Direct Support Professional
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- Overtime
- 18 years or older
- Clean driving record
- Computer literacy
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Physical Therapist
4U Home Health Care —Grand Rapids, MN
- From $55 an hour
- 8 hour shift
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Case Manager
The Mental Health Association of Columbia-Greene Counties, Inc. —Hudson, NY
- $20.00 - $22.50 an hour
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Licensed Practical Nurse (LPN)
Onewell Healthcare - Pennsylvania —Lebanon, PA
- $30 - $37 an hour
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Community Living Team Coordinator
Horizons Specialized Services —Steamboat Springs, CO
- $25.35 an hour
- Full-time
- Background check
- 18 years or older
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Classroom LBA/BCBA
Academy for Precision Learning —Seattle, WA
- $80,000 - $100,000 a year
- Full-time
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Supervisor of Case Management and Social Work Services
Ellis Medicine —Schenectady, NY
- $31.50 - $47.26 an hour
- Full-time
- RN License
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Case Manager
Community Resources For Justice —Manchester, NH
- $20 - $24 an hour
- Weekends as needed
- Background check
- Bachelor of Science
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Quick Apply
Physician (MD/DO) - Family Medicine
Celebrating Life Community Health Center —Mission Viejo, CA
- $250,000 - $270,000 a year
- Full-time
- Background check
- Spanish
- Medicine
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- Dental insurance
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8d
Licensed Practical Nurse (LPN)
Onewell Healthcare - Pennsylvania —Edinburg, PA
- $30 - $37 an hour
- Full-time
- CPR Certification
- Nursing
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- Mileage reimbursement
- Health savings account
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Clinician/Therapist (LMSW, LCSW, LMHC, LMFT, MHC-LP)
Family Services Inc. —Poughkeepsie, NY
- $55,000 - $75,000 a year
- Full-time
- LMFT
- Spanish
- Licensed Clinical Social Worker
- 403(b) matching
- AD&D insurance
Quick Apply
Registered Nurse (RN) – Hospice
Vivie —Baxter, MN
- $35.34 - $46.00 an hour
- Weekends as needed
- Background check
- CPR Certification
- RN License
- Paid holidays
- Health insurance
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Clinical Supervisor
Murtis Taylor Human Services System —Cleveland, OH
- $58,000 - $65,000 a year
- Weekends as needed
- LMFT
- Nursing
- Mid-level
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- Health insurance
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Utilization Management Clinician I

Community Health Plan of Washington -
Seattle, WA

Quick Apply

Job Details

Full-time
$35.92 - $55.67 an hour

Benefits

Paid jury duty
Health savings account
AD&D insurance
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Paid time off
Employee assistance program
Vision insurance
401(k) matching

Qualifications

Mid-level
Analysis skills
2 years
Communication skills
Time management

Full Job Description

This position is remote in Washington state.

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

Strive to apply an equity lens to all our work.
Reduce health disparities.
Create an equitable work environment.

About the Role

The Level I Utilization Management Clinician performs utilization review for medical or behavioral health requests using utilization review criteria, technologies, and tools. Identifies, coordinates, and implements high quality, cost-effective alternatives when appropriate to the patient’s condition. Supports physician decision-making, working collaboratively with all members of the health care team, the patient, the patient’s family, co-workers, and internal and external customers to achieve optimal patient outcomes. Ensures members have timely access to care and supports during transitions between levels of care. Understands and effectively communicates requirements and follows Community Health Plan of Washington (CHPW) policies and procedures.

To be successful in this role, you:

Have a bachelor’s degree in a relevant field or an equivalent combination of education and highly relevant experience.
Have a current, unrestricted license as an RN or LPN.
Have at least two years clinical experience in either a physical health or behavioral health setting.
Have previous experience in Utilization Management and Managed Care, preferred.

Essential functions and Roles and Responsibilities:

Conduct review of hospital notification or prior authorization care requests against established clinical guidelines and health plan policies.
Conduct onsite visits to local facilities 1-3 times weekly to connect with members and support successful post-discharge transitions.
Collaborate with facilities to perform discharge planning.
Provide coordination support to members transitioning between care settings or returning home from a hospitalization. Identifies member needs and provides support to ensure necessary services are available during the transition period.
Collaborates with providers, office staff, and Care Coordination team to assure coordination of care in a timely manner according to contractual and regulatory timeframes.
Identifies, coordinates, and ensures high quality care and appropriate care by focusing on supporting access to care and services across the continuum of care in accordance with the patient’s medical needs.
Identify potentially unnecessary services and/or delivery settings and recommends appropriate alternatives.
Identifies and determines medical necessity of out of network (OON) requests for services.
Assures referrals are complete and enrollment/eligibility benefits verified, prior to authorizing care.
Delivers timely written notification to patient or family members and communicates with members of the health care team.
Prepare cases that do not meet medical necessity or criteria for medical director review.
Communicate effectively with medical director regarding identified variances within the case against criteria utilized for medical review.
Regularly communicates with the UM Manager, Medical Director, physician advisor/reviewer and primary care physician for support, problem resolution and notification of decertification and appeals.
Using established screening tools, identify candidates and recommend enrollment into care management and disease management programs.
Identify quality of care issues and report for investigation per CHPW's policy.
Participates as part of the care management team; works collaboratively with all department staff.
Reporting to work on time and for all scheduled shifts is essential to this position.
Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

Ability to effectively manage and maintain quality standards for high volume of authorization.
Ability to work independently.
Effective written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers.
Knowledge in criteria set, including MCG, InterQual, ASAM, and LOCUS preferred.
Ability to multi-task and deal with complex assignments with competing priorities on a frequent basis.
Perform all functions of the job with accuracy, attention to detail and within established timeframes.
Effective analytical skills and the ability to interpret, evaluate and formulate action plans based upon data.
Experience in care management workflow systems.
Flexibility and willingness to work in a matrix-management environment.
Demonstrated organizational, time management, and project management skills.
Demonstrated proficiency and experience with Microsoft Office products.
Ability to present in a group setting.
Willingness to be part of a collaborative and dynamic clinical development team.
Collaborate with others in a respectful manner and ability to maintain confidentiality.

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn’t perfectly check every box in the job description, we encourage you to apply anyway.

As part of our hiring process, the following criteria must be met:

Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Non-Exempt and is eligible for overtime and has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors.

CHPW offers the following benefits for Full and Part-time employees and their dependents:

Medical, Prescription, Dental, and Vision
Telehealth app
Flexible Spending Accounts, Health Savings Accounts
Basic Life AD&D, Short and Long-Term Disability
Voluntary Life, Critical Care, and Long-Term Care Insurance
401(k) Retirement and generous employer match
Employee Assistance Program and Mental Fitness app
Financial Coaching, Identity Theft Protection
Time off including PTO accrual starting at 17 days per year.
40 hours Community Service volunteer time
10 standard holidays, 2 floating holidays
Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory*:

Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

Extended periods of sitting, computer use, talking and possibly standing
Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
Frequent torso/back static position; occasional stooping, bending, and twisting.
Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.

Mental:

Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.

Education

Preferred

Technical/other training or better in Nursing

Licenses & Certifications

Required

Behaviors

Required

Team Player: Works well as a member of a group
Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well

Motivations

Required

Self-Starter: Inspired to perform without outside help
Flexibility: Inspired to perform well when granted the ability to set your own schedule and goals

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Pay: $35.92 - $55.67 per hour

Quick Apply

Refine Your Search

Case Manager Exempt jobs

Utilization Management Clinician I

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Licensed Practical Nurse (LPN)

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Supervisor of Case Management and Social Work Services

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Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

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