Demonstrates strong leadership qualities including communication skills, organizational skills, problem solving and decision-making skills, Previous Managed Long-term Care (MLTC) and Uniformed Assessment Systems (UAS) experience, Bilingual (English and Spanish or Mandarin / Cantonese), Review clinical documentation to determine initial and ongoing eligibility for long term care benefits, Appropriately set follow up dates for ongoing benefit eligibility as prescribed by current protocols, Ongoing monitoring of claims for high risk activity, Professional clinician with a minimum of bachelor degree in nursing, Current R.N. Dakota Boys and Girls Ranch Treatment Center. Knowledge of managed care and state specific expertise preferred, Responsible for clinical decisions related to beneficiaries seeking access to their benefits for Mental HEalth or Substance Abuse Services for all levels of care using established criteri, guidelines and policies, Builds positive professional rapport with providers and communicates effectively, Utilizes rounds and case consultations woth Clinical Supervisor, Peer Advisor for cases outside criteria or not progressing, Coordinates with providers and other Care Managers to assure that patient comprehensive treatment needs are met and that there is continuity of patient care, Maintains confidentiality, ethical and professional standards, adhering to Clinical Policy and Procedures and Benefit Plan requirements, Performs concurrent reviews with treatment team providing ABA services, Performs initial case requests for autism services, behavioral health and ABA. Of the three types of resumes, the one you choose should be based on your work history, work experience, skills, and qualifications. Exhibits awareness of ethical/legal issues concerning patient care and strives to manage situations to reduce risk. The most successful candidates demonstrate throughout their resumes qualifications such as analytical thinking, communication and negotiation abilities, self-confidence, time management and leadership. Review caseload weekly with psychiatrist, focusing on patients not adequately improved within specified timeframe and when needed assist patient in scheduling appointment with the psychiatrist or any type of mental health referral, Master's degree in Social Work, Psychology or related field OR, Three (3) years of progressively responsible experience in social services required, One (1) year of supervisory experience recommended, Clinical and management experience in behavioral health and knowledge of chronic medical conditions is imperative, Experience working in a primary care setting, and collaborating with family medicine residents is a plus, Training in the three evidenced based practices will be provided at no cost to the Behavioral Specialist, Assist with moving members to in network facilities or coordinating with appropriate Community Care contracts regarding approval for out of network service utilization, Assumes responsibility for completion of acute and non-ambulatory precerts and application of appropriate medical necessity guidelines. Completes the Face to Face Health Functional Assessment and Service plan. And if you need more help, get a free resume evaluation from the experts at Monster's Resume Writing Service. Ensures proper receipt of equipment, home health and other services. Monitors the course of patients and the adherence of this course to clinical pathways or the patients' treatment plan. Please send resume and references to Clifford Walker, by mail to. Refer services to networked Providers when possible, Identify and address opportunities for quality improvement in all aspects of serving our customers. Developmental Disabilities ST of OK Human Resources, Interdisciplinary Team Leader/Qualified Developmental Disabilities Professional. Assess short-term and long-term needs and establishes care management objectives, Manages 60+ members based on case intensity and acuity. ), Provides individual client focused reports accentuating case management activity and outcome, Establishes a network of community resources (i.e., hospital discharge planners, AIDS counselors) necessary for providing appropriate care to patients, Serves as a program advocate by conducting training sessions, offering presentations, visiting providers, etc, Negotiates rates with vendors according to company policies and procedures, Facilitates the flow of claims through the Healthcare Management Department, Provides input (data, analysis or opinion) to the evaluation of the Program’s overall effectiveness, Make recommendations for system development from a user’s perspective, Participates in Quality Management initiatives, Complies with Healthcare Management policies and procedures and conforms to American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission standards while performing the job function, Reviews and signs CoreSource Confidentiality Attestation at the time of employment and at each annual performance review, Maintains active state nursing license and continuing education requirements and submits original copies of each to be photocopied for the employee file, Other duties as assigned by a Healthcare Management Supervisor or Director of Healthcare Management, Experience working with the Mental Health and/or Psychiatric population, Utilization Review or Discharge Planning background, Active New York State Registered Professional Nurse license, Experience working in any of the following areas: Geriatrics, Discharge Planning, Case Management, Assessment, Acute, Sub-Acute, Long-Term Care (LTC), Health insurance, Home care environment, Homeless population, Addiction, Foster care, Proficiency in navigating the Internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling), Intermediate skills with a Corporate email system including using and sharing calendar rights, MS Word, MS Excel and electronic patient health information (PHI) database usage (medical records database), Experience working with a frail adult or elderly population, Care management knowledge, including the concepts and philosophy and relevant standards of patient care, Experience with multiple Medicaid managed care plan products such as, Family Health Plus (FHP), Eastern Benefits System (EBS), Federal Employee Program (FEP), Experience: Three years of Clinical Nursing Experience, License: RN License in the state of Michigan, Skills & Abilities: Knowledge of chronic disease, evidence-based guidelines, prevention, wellness, health risk assessment, and patient education. As a DSP, my daily routine consisted of visiting the company’s patients at their homes and providing care … ), Knowledge of payer industry, resource management, reimbursement, and evidence-based clinical practice, Excellent relationship and management skills, including a high degree of psychological sophistication and non-aggressive assertiveness, Ability to problem solve, engage in abstract thought, and successfully manage conflicts, Strong negotiation, organizational, delegation and task prioritization skills, Ability to construct grammatically correct correspondence and reports using standard medical terminology, EMR, EPIC, Midas, ECIN, Interqual/Milliman, ACOEM experience, Minimum: Over 3 years and up to and including 5 years of experience in clinical setting demonstrating the ability to assess, document and implement the nursing care plan, Preferred: 3 to 5 years of acute nursing experience in critical care, Make clinical decisions related to assessment, referral, coordination of care, and appropriateness of care for members seeking access to their benefits for Mental Health or Substance Abuse services for all levels of care covered by contracts, Meet departmental standards related to clinical documentation, clinical policies and procedures, accreditation and regulatory standards and contract compliance, Actively participate in clinical rounds/case review process, and seeks consultation with the Clinical Director and Medical Director, As necessary, provide clinical oversight and consultation for non-clinical, unlicensed staff members, Actively participate in designated processes for managing the care of high-risk members, Critical thinking skills and ability to work independently, Must be able to work one weekend shift per month, Potential work from home opportunity after in office training, High school diploma or GED required. Social work case managers help make sure that individuals and families get … Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. MS Office including Outlook, Word, and Excel) and electronic medical records, Three to five years of Case Management experience preferred, This position will require the selected candidate to go to provider offices within Wayne and Oakland counties, Minimum 3 years’ experience in behavioral health/human services required, or other equivalent background and experience that would translate well to this position, Must hold a valid, unrestricted state license in a behavioral health specialty or nursing; acceptable licenses include but are not limited to LBSW, LMSW, RN, LPC, Must obtain CCM credential within 2 years of hire, Minimum 1 year of Care Management experience is preferred, Requires relevant experience/education to work with members with complex health, behavioral health, and psychosocial needs, The hours will be Monday-Friday 9:00 AM to 5:30 PM, Minimum of 3 years' clinical experience with an adult population in an acute care setting (e.g. Meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan, Acts as patient care liaison and initiates pre-admission discharge planning by screening for patients who are high-risk, fragile or scheduled for procedures that may require caregiver assistance, placement or home health follow-up, Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings. diabetes, sickle cell, asthma, etc. Documents case summary in Transitional Care Plan and shares appropriately with beneficiaries and providers. ), required, Ability to communicate well and effectively interact with team members and patients. Investigates and suggests alternatives. Provides ongoing evaluation of patient's progress throughout the acute, continuation and maintenance phases of the Stepped Care Model and coordinates with collaborative care team to augment care as needed. 1.6. The majority of the Clinical Care Managers work is done telephonically, Partner with the licensed nursing staff to plan, develop, organize, provide and execute individualized restorative therapy programs, Works with the chair of the department and the Director of Care Management to develop standards and education around medical necessity, Knowledgeable of Community Resources and Alternate Care facilities, Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload, Intermediate Ability to create, review and interpret treatment plans Ability to create, review and interpret treatment plans, Ability to troubleshoot or explain basic hardware and software errors and work with a Technician by remotely to perform step-by-step repairs, Excellent Interpersonal skills and ability to work effectively and independently, Able to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines, Detail oriented with strong organizational, planning, and problem solving skills, Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner, 3+ years of clinical experience with a focus in managed care, including disease or case management, Able to understand and apply coverage guidelines and benefit limitations, Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses (depression, challenging behaviors, Alzheimer’s disease and other disease-related dementias) in an ethnically diverse, dual-eligible aging population, Comfortable with conducting home visits and commuting within the service area, Basic computer skills and demonstrates a willingness to learn more advanced skills, MLTC experience, including appropriate support services in the community and accessing and using durable medical equipment (DME), Minimum of 3 years of clinical work in orthopedics, physical rehab or case management, Experience in an outpatient or inpatient setting, NJ Nurse Practitioner (NP) or Advanced Nurse Practitioner Nurse (ANP) license, Experience as an Advanced Nurse Practitioner (ANP) with ICU and/or ER experience, Previous Counseling / Advising experience, Self-motivation, organization and flexibility, Commitment to improve care in underserved populations, Home care, long term care, care management experience, Knowledge of the case management and utilization review process $, Registered Nurse licensure in New York State, A minimum of two (2) to three (3) years of clinical experience in a certified Home health agency (CHHA), Lombardi program and/or MLTC, Excellent communication, written and analytical skills, Serves as a point of contact for internal and external clients including: screening phone calls, ensuring client messages are communicated to the appropriate client service staff, and following up with clients, when appropriate, Provides general administrative support to partners, including but not limited to, High School Diploma/GED required; College coursework/degree preferred, A minimum of 2 years of experience in an administrative role is required, Experience in a professional services firm preferred, Capability to work in a fast paced environment and under pressure, Advanced skills with Microsoft Office, specifically Outlook & Excel, Experience in accounting procedures preferred, Flexibility with overtime to meet deadlines, Familiar with either CAP or NYS Point of Care (POC) requirements, Experience as a Chemistry Supervisor, Hematology Supervisor, Coagulation Supervisor, or CORE lab supervisor, Able to multi-task and enjoy working in a fast-paced, team environment, 2+ years of Clinical background and experience, Knowledgeable with assessments, and work in a fast-paced environment, PRI certified and have Utilization and/or Concurrent Review experience with an acute care facility, Develop/manage the patient care transition process which includes coordinating, facilitating and assisting patients throughout the episode of care, Serve as clinical resource with expertise in musculoskeletal patient care management and serve as liaison regarding services for this patient population, Oversee the process for clinical pathway development, staff training, and data collection and reporting, Act as a positive role model as a nursing leader, 3+ years of related experience as a medical/surgical nurse, 2 years of UM or case management experience, Strong ability to develop, guide, motivate, nurture, and coach others, Dealing with Medicaid/Medicare members, perform pre-admission, concurrent and retrospective reviews to evaluate appropriateness of admission, need for continued stay, length of stay, utilization of resources, patient outcomes, and usage of other services post-encounter, Document all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards to insure integrity of member services, Identify opportunities and facilitate member transfers to: a) hospital of enrollment/other appropriate in-network hospital when hospitalization occurs out-of-network; or b) hospital of enrollment when hospitalization occurs at another network hospital, 5+ years relevant UM or Case Management experience, LMSW, LCSW, Mental Health Counselor, or RN license, Experience with mental health and substance abuse, Psych, Discharge Planning, Chemical Dependency, CCM, Case Management, Behavioral, Ambulatory, Care management experience in prenatal service/obstetrical care management, IVF experience or IVF case management experience, Proficiency in Utilization Review, OB/GYN, IVF/Infertility, and Case Management, 3+ years of experience in an Outpatient, Orthopedic, or Acute Care setting, Previous Managed Care and Pain Management experience, Utilization and/or Concurrent Review experience, Advocates for the members’ needs, addresses concerns and resolves, Facilitates the completion of Medicaid and other benefits programs eligibility application process for members and monitors the process, Attends a minimum of one networking event each month to promote AEC services within the community, Bachelor’s Degree in Social Work, Sociology, Psychology, Gerontology or a related field, Two or more years of case management experience, Valid Driver’s License and current auto insurance, Complete needs surveys regarding psychological, emotional and environmental resources, for the purpose of providing appropriate, timely interventions to ensure provision of optimal care, Coordinate community care and services as deemed appropriate, Work collaboratively with other members of the Humana At Home Interdisciplinary team-to include: Humana At Home Care Managers, Field Care Managers, and Community Health Educators, Minimum 3 years of care/case management experience with adults, Knowledge of community health, community resources, and social service agencies, Ability to interact effectively with multi-disciplinary team members, Self-starter who is able to multi-task and prioritize, Must have a separate room with a locked door that can be used as a home office to ensure you and our members have absolute and continuous privacy while you work, Must have accessibility to high speed DSL or Cable modem internet for your home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance form Humana systems is 10M X 1M, Ability to work a full-time (40 hours minimum) flexible work schedule, Previous work with vulnerable adults or geriatric population, Licensed in your residential state (ND, SD, NV, UT, LA, AL, OK), Ability to work a full-time (40 hours minimum) Monday - Friday, Central and mountain time zones would be a plus, 3 years of experience in home case/care management, MUST LIVE within 10-15 MILES of Hampton, VA, Valid Registered Nurse (RN) with no disciplinary action in the stateof TEXAS, One year of field based eldercare with Home Care and/or caremanagement environment, This role is considered to patient and is a part of Humana At Home Tuberculosis(TB) screening program. , Expert in documentation, communication, teamwork, and in navigating the health team. 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