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case management manager

Emory Healthcare

<div>Overview:
<div><b>
Be inspired. Be valued. Belong.</b></div><div></div><div><br>
At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:</div><ul><li>
Comprehensive health benefits that start day 1</li><li>
Student Loan Repayment Assistance &amp; Reimbursement Programs</li><li>
Family-focused benefits
</li><li>Wellness incentives</li></ul><div>
Ongoing mentorship, development, leadership programs...and more!</div>
Description:
<div>
The Care Manager is responsible for patient care coordination from admission through discharge; ensuring smooth transitions of care as the patient is discharged from the hospital setting, ensuring and facilitating high quality clinical and cost outcomes, procuring and securing post-acute services, coordinating and advocating for patients and families with both internal and external stakeholders, and identifying and addressing potential barriers to care coordination/discharge planning in an effort to foster efficient care delivery and maximize reimbursement. The Care Manager will begin the process of care coordination at the time of the patient's admission by completing a thorough admission assessment and/or psychosocial assessment which will allow for a timely and accurate capture of information as well as foster the ability to begin working towards a discharge plan. The Care Manager is an integral part of the interdisciplinary care team who is required to attend rounds, care conferences, and/or care team meetings. The Care Manager will act as a representative of both the hospital care team and the patient/family in an effort to balance patient/family choice and projected care coordination needs with the ability to execute such services. The Care Manager will work with the hospital care team and the patient/family in order to plan and implement the best possible plan for the patient while taking various factors, limitations, and patient/family preference into consideration. The Care Manager will identify and recommend post-acute services and will complete referrals to appropriate post-acute care providers in a timely manner, coordinating directly with the patient/family as well as the care team. Through continuous assessment and review, the Care Manager will apply critical thinking to ensure alignment and appropriateness of post acute services as the patient clinically progresses throughout their stay. Ultimately, the Care Manager is responsible for ensuring the discharge plan is aligned to be executed with the patient's medically cleared for discharge date as well as the projected length of stay as provided by the payor. The Care Manager identifies and participates in the development of strategies to reduce unnecessary length of stay and/or resource consumption. The Care Manager escalates cases, as appropriate, to management, Physician Advisor, Complex Care team and/or Ethics committee. It is the role of the Care Manager to educate patients/families as well as the care team as it relates to post acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices and available resources. The Care Manager provides supportive and therapeutic communication for patients, families and loved ones who are experiencing anxiety or stress due to illness, injury or physical limitations. The Care Manager must communicate confidently, effectively, and therapeutically while being assertive and conveying an impression which reflects favorably upon the organization The Care Manager will initiate and facilitate discussions with the payors in order to act as an advocate on behalf of the patient and hospital in an effort to reduce non-covered, non-authorized, or denied services. The Care Manager will issue and administer notices of non-coverage and potential liability to patients in accordance with predetermined regulations, policies, and procedures. The Care Manager serves as a resource to the Physician, Interdisciplinary Care Team, and patient for the interpretation of external regulations and organizational policies and procedures as it pertains to Discharge Planning and Care Coordination. The Care Manager will ensure compliance with all regulatory requirements as it relates to Government and Commercial Payors. The Care Manager will ensure compliance with all third party payers and federal and state regulatory agencies. The Care Manager will ensure proper use of Case Management Systems and workflows.</div><div></div><div><br>
Minimum Qualifications:</div><div>
RN CM: MINIMUM REQUIRMENTS 1. Valid, unencumbered Registered Nurse License approved by the Georgia Board of Nursing. 2. Two (2) years experience in healthcare. PREFERRED 1. Bachelors degree in Nursing from an accredited school of nursing.</div><div>
SW CM I: MINIMUM REQUIREMENTS 1. Masters in Social Work from an accredited school of social work. 2. Demonstrated knowledge of software/EMR applications.</div><div>
PREFERRED 1. One (1) year healthcare experience in Acute Care setting. 2. Accredited Case Manager (ACM) Certification through the American Case Management Association or Certified Case Management (CCM) through the Commission for Case Manager Certification.</div><div></div><div><br>
SW CM II: MINIMUM REQUIREMENTS 1. Masters in Social Work from an accredited school of social work. 2. Licensed as a Master Social Worker (LMSW) through the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage &amp; Family Therapists. 3. Demonstrated knowledge of software/EMR applications.</div><div>
PREFERRED 1. Two (2) years healthcare experience in Acute Care setting. 2. Accredited Case Manager (ACM) Certification through the American Case Management Association or Certified Case Management (CCM) through the Commission for Case Manager Certification.</div><div></div><div><br>
SW CM III: MINIMUM REQUIREMENTS 1. Masters in Social Work from an accredited school of social work. 2. Licensed as a Clinical Social Worker (LCSW) through the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage &amp; Family Therapists. 3. Demonstrated knowledge of software/EMR applications</div><div>
PREFERRED 1. Three (3) years healthcare experience in Acute Care setting. 2. Accredited Case Manager (ACM) Certification through the American Case Management Association or Certified Case Management (CCM) through the Commission for Case Manager Certification. productivity expectations and successfully complete yearly competencies.</div><div></div><div><b><br>
JOIN OUR TEAM TODAY!</b> Emory Healthcare (EHC), part of Emory University (EUV), is the most comprehensive academic health system in Georgia and the first and only in Georgia with a Magnet&reg; designated ambulatory practice. We are made up of 11 hospitals-4 Magnet&reg; designated, the Emory Clinic, and more than 425 provider locations. The Emory Healthcare Network, established in 2011, is the largest clinically integrated network in Georgia, with more than 3,450 physicians concentrating in 70 different subspecialties.</div>
Additional Details:
<div>
Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.</div><div></div><div><br>
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare&rsquo;s Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.</div></div>

Care Manager IP

Morgan & Morgan, P.A.

<div>
 <p>
  <span>
   At Morgan &amp; Morgan, the work we do matters. For millions of Americans, we&rsquo;re their last line of defense against insurance companies, large corporations or defective goods. From attorneys in all 50 states, to client support staff, creative marketing to operations teams, every member of our firm has a key role to play in the winning fight for consumer rights. Our over 6,000 employees are all united by one mission: For the People.
  </span>
 </p>
 <p>
  <strong>
   Summary
  </strong>
 </p>
 <p>
  We are seeking a Case Manager to join our team. As a Case Manager you must be highly organized and able to work on a varied caseload. The Case Manager will assist the attorney in developing settlements, preparing documents and correspondence as needed. The ideal candidate is customer focused and empathetic.
 </p>
 <p>
  <strong>
   Responsibilities
  </strong>
 </p>
 <ul>
  <li>
   Daily interaction with existing and potential clients, via telephone and in person.
  </li>
  <li>
   Order medical records from providers and communicate with clients and providers during the course of treatment.
  </li>
  <li>
   Obtain documents necessary to support injury and/or liability positions
  </li>
  <li>
   Interact with insurance carriers and healthcare providers to secure records and account balances
  </li>
  <li>
   Negotiate case settlements with insurance carriers and negotiate a deduction of outstanding medical balances with providers
  </li>
  <li>
   Work directly with multiple coworkers involved in the management and support of case files
  </li>
  <li>
   Maintain organized case files.
  </li>
  <li>
   Prepare comprehensive demands and assemble support for submission to carriers
  </li>
  <li>
   Interact with attorneys and present case synopsis when required
  </li>
  <li>
   Manage case files from intake to closing under the direction of an attorney
  </li>
  <li>
   Performs other related duties as assigned to meet the needs of the business
  </li>
 </ul>
 <p>
  <strong>
   Qualification
  </strong>
 </p>
 <ul>
  <li>
   Bachelor&rsquo;s degree (preferred)
  </li>
  <li>
   Prior experience as a Personal Injury Case Manager preferred.
  </li>
  <li>
   At least 2 years of working in a legal position or insurance adjuster experience preferred.
  </li>
  <li>
   Negotiating skills.
  </li>
  <li>
   Ability to be a team player and follow procedures.
  </li>
  <li>
   Proactive interaction with clients, insurance companies and medical providers.
  </li>
  <li>
   Must possess the ability to multi-task, prioritize, and manage workload with a positive attitude and minimal supervision.
  </li>
  <li>
   Highly organized with the ability to juggle multiple deadlines in a fast-paced environment
  </li>
  <li>
   Strong writing and communication skills along with attention to detail
  </li>
  <li>
   Extensive computer and database expertise, Microsoft Word, Excel, Outlook, and type no less than 35 wpm.
  </li>
  <li>
   <strong>
    Not remote eligible&nbsp;
   </strong>
  </li>
 </ul>
 <p>
 </p>
 <p>
  <strong>
   Benefits
  </strong>
 </p>
 <p>
  <span>
   Morgan &amp; Morgan is a leading personal injury law firm dedicated to protecting the people, not the powerful. This success starts with our staff.&nbsp; For full-time employees, we offer an excellent benefits package including medical and dental insurance, 401(k) plan,&nbsp; paid time off and paid holidays.
  </span>
 </p>
 <p>
  <strong>
   Equal Opportunity Statement
  </strong>
 </p>
 <p>
  <span>
   Morgan &amp; Morgan provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
  </span>
 </p>
 <p>
  <strong>
   E-Verify
  </strong>
 </p>
 <p>
  <span>
   This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the I-9 Form.&nbsp;&nbsp;&nbsp;
  </span>
 </p>
 <p>
  <strong>
   Privacy Policy
  </strong>
 </p>
 <p>
  <span>
   Here is a link to Morgan &amp; Morgan's privacy policy.
  </span>
 </p>
</div>


Case Manager

<div>
 <p>
  <span>
   At Morgan &amp; Morgan, the work we do matters. For millions of Americans, we&rsquo;re their last line of defense against insurance companies, large corporations or defective goods. From attorneys in all 50 states, to client support staff, creative marketing to operations teams, every member of our firm has a key role to play in the winning fight for consumer rights. Our over 6,000 employees are all united by one mission: For the People.
  </span>
 </p>
 <p>
  <strong>
   Summary
  </strong>
 </p>
 <p>
  We are seeking a
  <strong>
   Case Manager
  </strong>
  to join our team. As a Case Manager you must be highly organized and able to work on a varied caseload. The Case Manager will assist the attorney in developing settlements, preparing documents and correspondence as needed. The ideal candidate is customer focused and empathetic.
 </p>
 <p>
  <strong>
   Responsibilities
  </strong>
 </p>
 <ul>
  <li>
   Daily interaction with existing and potential clients, via telephone and in person.
  </li>
  <li>
   Order medical records from providers and communicate with clients and providers during the course of treatment.
  </li>
  <li>
   Obtain documents necessary to support injury and/or liability positions
  </li>
  <li>
   Interact with insurance carriers and healthcare providers to secure records and account balances
  </li>
  <li>
   Work directly with multiple coworkers involved in the management and support of case files
  </li>
  <li>
   Maintain organized case files.
  </li>
  <li>
   Prepare comprehensive demands and assemble support for submission to carriers under the direct supervision of an attorney
  </li>
  <li>
   Interact with attorneys and present case synopsis when required
  </li>
  <li>
   Manage case files from intake to closing under the direction of an attorney
  </li>
  <li>
   Performs other related duties as assigned to meet the needs of the business
  </li>
 </ul>
 <p>
  <strong>
   Qualification
  </strong>
 </p>
 <ul>
  <li>
   Bachelor&rsquo;s degree (preferred)
  </li>
  <li>
   Prior experience as a Personal Injury Case Manager preferred.
  </li>
  <li>
   At least 2 years of working in a legal position or insurance adjuster experience preferred.
  </li>
  <li>
   Ability to be a team player and follow procedures.
  </li>
  <li>
   Proactive interaction with clients, insurance companies and medical providers.
  </li>
  <li>
   Must possess the ability to multi-task, prioritize, and manage workload with a positive attitude and minimal supervision.
  </li>
  <li>
   Highly organized with the ability to juggle multiple deadlines in a fast-paced environment
  </li>
  <li>
   Strong writing and communication skills along with attention to detail
  </li>
  <li>
   Extensive computer and database expertise, Microsoft Word, Excel, Outlook, and type no less than 35 wpm.
  </li>
 </ul>
 <p>
  <em>
   <span>
    This role is on-site, which gives you the chance to be fully immersed in the work and gain direct experience alongside the team.
   </span>
  </em>
 </p>
 <p>
 </p>
 <p>
  <strong>
   Benefits
  </strong>
 </p>
 <p>
  <span>
   Morgan &amp; Morgan is a leading personal injury law firm dedicated to protecting the people, not the powerful. This success starts with our staff.&nbsp; For full-time employees, we offer an excellent benefits package including medical and dental insurance, 401(k) plan,&nbsp; paid time off and paid holidays.
  </span>
 </p>
 <p>
  <strong>
   Equal Opportunity Statement
  </strong>
 </p>
 <p>
  <span>
   Morgan &amp; Morgan provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
  </span>
 </p>
 <p>
  <strong>
   E-Verify
  </strong>
 </p>
 <p>
  <span>
   This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the I-9 Form.&nbsp;&nbsp;&nbsp;
  </span>
 </p>
 <p>
  <strong>
   Privacy Policy
  </strong>
 </p>
 <p>
  <span>
   Here is a link to Morgan &amp; Morgan's privacy policy.
  </span>
 </p>
</div>


Alexander Shunnarah Trial Attorneys

<div><div><h1 class="jobSectionHeader"><b>Why Work For Us</b></h1>
<p>
Alexander Shunnarah Trial Attorneys is a rapidly growing personal injury law firm based in Alabama with offices across the nation. We handle complex cases and provide each attorney and staff with the support they need enabling us to best serve our clients. Our attorneys and staff pride themselves on their skill set, experience, compassion, and commitment. We are dedicated to giving our clients the utmost attention and care while fighting for them to get what they deserve.</p>
<p>
At Alexander Shunnarah Trial Attorneys, we take a real approach. We are innovative, always finding ways to be better, and have a go-getter mentality across the board. Each team member plays a critical role in our mission. We know our people are what makes us great. If you're looking for a career where you can help make a difference in the lives of others alongside a supportive team, we encourage you to apply!</p>
<h1 class="jobSectionHeader"><b>
What We Value</b></h1>
<ul><li>Client Commitment</li>
<li>Integrity</li>
<li>A Will to Win</li>
<li>Teamwork</li>
<li>Personal Accountability</li>
<li>Passion</li>
</ul></div><p>
Are you ready to make a significant impact in personal injury cases? We're on the lookout for a dedicated and detail-oriented Case Manager to join our team and support our attorneys through all phases of pre-litigation and some litigation. If you're passionate about client advocacy and thrive in a fast-paced environment, this role is perfect for you!<br>
<br>
This is a 100% on site position. We believe this work is done best together!</p>
<h1 class="jobSectionHeader"><b>
What You'll Do:</b></h1>
<ul><li><b>Drive Success:</b> Manage personal injury pre-litigation and some litigation cases, providing essential support to attorneys and clients.</li>
<li><b>Be a Key Player:</b> Work closely with attorneys throughout all phases of pre-litigation, ensuring smooth and efficient case progression.</li>
<li><b>Engage Directly:</b> Maintain effective communication with clients, providers, and insurance companies, handling inquiries and updates with precision.</li>
<li><b>Stay Organized:</b> Utilize your organizational skills and proactive approach to manage documents, deadlines, and case details effectively.</li>
</ul><h1 class="jobSectionHeader"><b>What You Need:</b></h1>
<ul><li><b>Experience:</b>
<ul><li>Minimum 1 year of Legal Case Manager experience required; 3-5 years preferred</li>
<li>Proven ability in drafting and reviewing legal documents.</li>
<li>Experience in medical records management and understanding personal injury cases (highly preferred).</li>
</ul></li><li><b>Tech-Savvy:</b> Proficiency in Microsoft Office (2 years required) and familiarity with FileVine or other case management systems (preferred).</li>
<li><b>Communication Skills:</b> Excellent verbal and written communication skills are essential for this role.</li>
</ul><h1 class="jobSectionHeader"><b>What You Get:</b></h1>
<ul><li><b>A Great Role:</b> Full-time position with opportunities to grow and contribute to impactful cases.</li>
<li><b>Comprehensive Benefits:</b> Dental, vision, and health insurance, plus supplemental insurance and paid time off.</li>
<li><b>A Supportive Environment:</b> Join a team that values collaboration, innovation, and your professional development.</li>
</ul>
<p><b>Ready to advance your career and make a real difference?</b> Apply now and become a vital part of our dedicated team!</p><div><p>
Alexander Shunnarah Trial Attorneys is committed to a diverse and inclusive workplace. Alexander Shunnarah Trial Attorneys is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status. For individuals with disabilities who would like to request an accommodation, please email <b>careers@asilpc.com</b>.</p></div></div>

Morgan & Morgan

<div><div><p>At Morgan &amp; Morgan, the work we do matters. For millions of Americans, we're their last line of defense against insurance companies, large corporations or defective goods. From attorneys in all 50 states, to client support staff, creative marketing to operations teams, every member of our firm has a key role to play in the winning fight for consumer rights. Our over 6,000 employees are all united by one mission: For the People.</p></div><p>
We are seeking a qualified <b>Case Manager in Training. </b>In this role, you will be responsible for managing the law firm's day-to-day operations, including carrying out administrative services and supporting the legal team. This position's ideal candidate has a strong work ethic, exceptional problem-solving skills, and comfortable working in a fast-paced dynamic workplace.</p>
<p><b>
Compensation for this role is $20 an hour.</b></p>
<p><b>
Responsibilities</b></p>
<ul>
<li>Assist case managers and attorneys with organizing, filing, and maintaining of client files up to 100+ cases</li>
<li>Collect check request for medical records, accident reports, driving records and vehicle ownership as requested and submit for processing</li>
<li>Copy documents and demand packages as requested</li>
<li>Complete certified mail cards and mail documents and cost checks as requested</li>
<li>Perform general office duties such as typing, operating office machines, and sorting mail</li>
<li>Create new and existing client folders</li>
<li>Prepare and send turndowns and no representation letters, contracts, and multi-party combo letters</li>
<li>Send out demand letters</li>
<li>Performs other related duties as assigned to meet the needs of the business</li>
</ul>
<p><b>Requirements</b></p>
<ul>
<li>Associate degree, certificate, or equivalent work experience (preferred)</li>
<li>Bilingual English and Spanish (preferred)</li>
<li>1 year of experience in the legal field a plus!</li>
<li>Knowledge of administrative and clerical procedures and systems such as word processing, managing of files and records, and other office procedures</li>
<li>Must possess the ability to multi-task, prioritize, handle a fast-paced environment, and manage workload with a positive attitude and minimal supervision</li>
<li>Great written and communication skills</li>
<li>Highly organized with the ability to juggle multiple deadlines in a fast-paced environment</li>
<li>Strong writing and communication skills along with attention to detail</li>
<li>Extensive computer and database expertise, Microsoft Word, Excel, Outlook, and type no less than 35 wpm</li>
</ul>
<p></p><p><i>This role is on-site, which gives you the chance to be fully immersed in the work and gain direct experience alongside the team.</i></p>
<p>
#LI-MP1</p><div><p><b>
Benefits</b></p>
<p>
Morgan &amp; Morgan is a leading personal injury law firm dedicated to protecting the people, not the powerful. This success starts with our staff. For full-time employees, we offer an excellent benefits package including medical and dental insurance, 401(k) plan, paid time off and paid holidays.</p>
<p><b>
Equal Opportunity Statement</b></p>
<p>
Morgan &amp; Morgan provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.</p>
<p><b>
E-Verify</b></p>
<p>
This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the I-9 Form.
</p><p><b>Privacy Policy</b></p>
<p>
Here is a link to Morgan &amp; Morgan's privacy policy.</p></div></div>

Case Manager in Training

Kaiser Permanente

<div><div><b>Job Summary:</b></div><br>
<br>
<p>The Complex Case Manager is a Nationally Board Certified Professional. He/she is responsible for performing all activities on members referred to the complex case management program. This includes a comprehensive clinical evaluation, assessment and documented care plan in all domains including social determinants of health, psycho-social, financial, medications, ADL/IADLs and cognitive, coordinating and monitoring all services needed with a focus on providing education and the goal of self-management skills. Additional responsibilities include ensuring continuity of care through interaction and team- work with the Inpatient Case/Care Managers, Transition of Care staff, QRM staff, Population Care staff, Medical Office staff, Social Workers, Vendors and other KPGA staff. Educates Providers, member and caregivers and the promotion of quality care and a high level of member and/or caregiver satisfaction. The Complex Case Manager will ensure work demonstrates adherence to NCQA Standards of Excellence.</p><div><b><br>
Essential Responsibilities:</b></div><br>
<br>
<ul><li>Reviews all referrals to the Complex Case Management Programs within designated timeframe per policy and procedure and evaluate for case management based on established guidelines to ensure compliance with NCQA standards. This includes the preliminary evaluation of benefits within KPGA and community resources available.</li><li>
Performs a thorough and objective assessment of the member including physical, psychosocial, environmental, financial, and health status expectation through the use of EMR and hospital records, contact with the member, significant others, caregivers and current medical caregivers (if permitted by the member).</li><li>
Obtains consent from the member/caregiver for participation in Complex Case Management.</li><li>
Develops a comprehensive plan of care based on the assessment and in conjunction with the treating practitioner, identifies specific interventions, objectives, and goals with anticipated targeted dates for member accomplishment and self-management.</li><li>
Communicates the plan of care to the member/caregiver and provides education to the regarding the members condition as necessary.</li><li>
Implements the plan of care and specific interventions that will lead to the accomplishment of goals as defined in the plan of care.</li><li>
Establishes specific dates for follow-up and assesses the members status and progress toward the established goals and adjusts the plan of care as necessary.</li><li>
Performs referrals to other KPGA programs and coordinate referrals to community resources necessary to accomplish the goals and makes recommendations for modifications to the plan of care as necessary.</li><li>
Continuously evaluates and monitors all activities and/or services provided through the case management plan to determine the effectiveness of the plan.</li><li>
Documents all case management interactions and interventions according to guidelines including any pertinent patient information or arrangements in the members medical record.</li><li>
Identifies and Evaluates expected outcomes, utilization of services and associated costs of the plan of care as well as any proposed alternative plan of care and makes the necessary revisions.</li><li>
Coordinates and participates in case conferences on a regular basis with all Providers involved in the care and updates the plan of care as necessary.</li><li>
Continuously coordinates, monitors, tracks and evaluates all care and services rendered to ensure that quality care is being delivered in the most appropriate setting.</li><li>
Assists in the development and implementation of Continuous Quality Improvement (CQI) projects.</li><li>
Works closely with the member and practitioner to ensure that the most appropriate and cost- effective services are always provided to the member while maintaining quality outcomes.</li><li>
Performs hospital discharge follow up on assigned population. Arranges, coordinates, and facilitates appointments for the member as necessary.</li><li>
Maintains effective interaction/communication with members, nursing staff, inpatient care coordinators, the transitional review team, social workers, general reviewers, referral coordinators, and Kaiser Permanente medical offices to facilitate the case management process and to provide continuity of care.</li><li>
Identifies the need for discharge from the Case Management Program based on defined goals and criteria, and discharges the member after notifying the member and practitioner as well as any other resources such as the Social Worker, Transitional Review Team, etc.</li><li>
Performs as an integrated health care team member, providing continual education to HCT staff as to role and responsibilities in care coordination. Remains accessible to the HCT and attends all HCT meetings as appropriate.</li><li>
Collaborates effectively with Providers and other departments within the health plan by acting as a resource to TSPMG Providers, contracted consultants, Health Plan administrators and medical office staff and other departments within the organization.</li><li>
Provides case management updates to Providers and health care teams.</li><li>
Performs home visits as appropriate for members in case management.</li><li>
Knowledgeable and compliant with regional personnel, unit specific and departmental policies and procedures. Assists in the development of department protocols as needed.</li><li>
Participates in annual regional and departmental compliance training.</li><li>
Knowledgeable and compliant with Principles of Responsibility.</li><li>
Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanentes policies and procedures.</li><li>
Access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform the job.</li><li>
Demonstrates understanding of HIPAA privacy regulations by maintaining confidentiality of Protected Health Information (PHI).</li><li>
Demonstrates doing the right thing and doing things the right way is an underlying premise in all work- related activities and is able to identify location of copy of Principles of Responsibility.</li><li>
Develops and maintains an awareness of how to report compliance issues and concerns. Identifies issues of wrong- doing and promptly investigates and reports to immediate supervisor or Director of Regional Compliance. Serves as a primary contact person between the medical offices and community agencies as it relates to coordinating and facilitating the appropriate level of care and provision of services.</li><li>
Collaborates with the social worker to provide information to members and HCTs regarding community resource referrals.</li><li>
Remains knowledgeable of contract benefits and current, industry utilization trends relevant state and Federal regulations, criteria, documentation requirements (including Medicare and HCFA) and laws that affect managed care and case/utilization management.</li><li>
Investigates, identifies and reports problems and inefficiencies in existing systems, and recommends changes when appropriate to the Team Leader and/or Manager.</li><li>
Under the guidance of the Team Leader and in consultation with other QRM and IQM staff, participates in the coordination, planning, development, implementation, and maintenance of all Complex Case Management Program department policies and procedures.</li><li>
Reviews the statistics of case management interventions with the Supervisor/Team Leader and adjusts based on findings.</li><li>
Performs quality of care and service reviews using identified quality indicators and refers cases identified as risk management, peer review or quality issues to Quality and Risk Management.</li></ul><div><br>
<b>Basic Qualifications:</b></div>
<div>Experience</div><br>
<br>
<ul><li>Minimum five (5) years of RN Clinical Nursing, social work, case management or utilization management (UM).</li><li>
Equivalent combination of case management/social work/UM training or RN experience may be considered.</li></ul><div>
Education</div><br>
<br>
<ul><li>High School Diploma or General Education Development (GED) required.</li></ul><div>
License, Certification, Registration</div>
<ul><li>Licensed Master Social Worker (Georgia) OR Licensed Clinical Social Worker (Georgia) OR Registered Professional Nurse License (Georgia) required at hire
</li></ul><ul><li>Case Manager Certificate within 12 months of hire from Commission for Case Managers Certification<br>
</li></ul><div>
<b>Additional Requirements:</b></div><br>
<ul><li>
Complex Case Management experience and/or certification.
</li><li>Excellent/highly skilled in the management of chronic conditions such as diabetes, cardiovascular conditions, behavioral-health, and chronic obstructive lung disease management COPD.</li><li>
Ability to work collaboratively with multiple healthcare professionals.</li><li>
Experience with managed health care delivery, benefits knowledge including Medicare and Medicaid.</li><li>
Functional knowledge of computers.</li><li>
Knowledge of ICD9/ ICD10 and/or CPT4 coding beneficial.</li><li>
Working knowledge of all relevant federal, state, local and regulatory requirements including Medicare/HCFA.</li></ul><div>
<b>Preferred Qualifications:</b></div><br>
<br>
<ul><li>Bachelors Degree in Nursing strongly preferred or four (4) years of experience in related field.</li></ul><br>
PrimaryLocation : Georgia,Atlanta,Regional Office - 9 Piedmont<br>
HoursPerWeek : 40<br>
Shift : Day<br>
Workdays : Mon, Tue, Wed, Thu, Fri<br>
WorkingHoursStart : 08:30 AM<br>
WorkingHoursEnd : 05:00 PM<br>
Job Schedule : Full-time<br>
Job Type : Standard<br>
Employee Status : Regular<br>
Employee Group/Union Affiliation : GUP|UFCW|Local 1996<br>
Job Level : Individual Contributor<br>
Job Category : QA, UR &amp; Case Management<br>
Department : Regional Office - 9 Piedmont - Rgnl Mg Admn-Ccs Case Coord - 2808<br>
Travel : No<br>
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.</div>

Complex Case Manager

The Home Depot

<div>
 Req173739
 <br/>
 <br/>
 <strong>
  Position Purpose
  <br/>
  <br/>
 </strong>
 As a member of the Central Investigation Team (CIT), the Central Investigator is responsible for the direction and support of Organized Retail Fraud (ORC) investigations theft and fraud investigations within a specified area of the company. The CIT will work with various business partners (IT, Internal Audit, RDO's, DOM's, Store Ops, APM's and APS') and leverage all available investigative tools to eliminate and reduce company exposure to associate and external theft. Key responsibilities include: analyzing information, determination of exception data to drive investigation, communication and coordination of information to field teams and other partners and management of the investigative process. Coordination with law enforcement to ensure effective prosecution and restitution recovery The Central Investigator will collaborate, coordination with IT to develop new exception data, management of remote CCTV viewing to support investigative efforts, and case trend analysis to drive performance and to make recommendations to mitigate theft exposure. The CIT must be able to manage multiple tasks and to gain buy in and support of multiple partners to ensure a successful investigation process within their area of responsibility. The CIT must be effective at training and coaching, as they will support the field in understanding development of the investigative skill sets theft exposures within their area of responsibility. The CIT must have strong analytical and problem solving skills, as they will make recommendations to business partners for the elimination of procedural/policy issues that increase theft exposure. The CIT will report directly to the Manager of Central Investigations and will work in a collaborative team environment with the entire CIT Team.
 <br/>
 <br/>
 <strong>
  Key Responsibilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   30% Leveraging store systems and data query models to isolate theft and fraud indicators. Utilize information from systems reports and databases to identify and communicate criminal activity impacting company assets. Utilizes multiple data sources, E-Platforms and Social Media to help identify theft trends.
  </li>
  <li>
   25% Execution of CCTV Alerts and SSC generated alerts to identify, internal and external theft through mitigating opportunities. Develop and maintain strong working relationships with HR to resolve associate issues related to theft and fraud. Develop partnership with APMs' and APS' to drive theft and fraud elimination.
  </li>
  <li>
   25% Packaging and Building cases. Updates case management and initiates quality case leads for investigation, providing actionable data and investigative support. Coordinates documentation and video. Provides weekly updates to manager on case load and case management efforts.
  </li>
  <li>
   20% Communicating cases and handing off investigations. Gathers intelligence and collaborates with Law Enforcement on Serious Incidents (SIRs). Maintains relationships with financial institutions and industry partners.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Direct Manager/Direct Reports
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   This position reports to SSC AP Manager.
  </li>
  <li>
   This position has 0 direct reports.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Travel Requirements
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Typically requires overnight travel less than 10% of the time.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Physical Requirements
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Most all of the time is spent sitting in the same position or standing/walking or there is some requirement to lift or handle material or equipment of moderate weight (8-20 pounds).
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Working Conditions
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Typically located in a comfortable indoor area. There may be regular exposure to mild physical discomfort from factors such as dust, fumes or odors, temperature extremes, loud noise, strong drafts, or bright lights.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Minimum Qualifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Must be eighteen years of age or older.
  </li>
  <li>
   Must be legally permitted to work in the United States.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Qualifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   3+ Years of Loss Prevention / Asset Protection Investigative experience
  </li>
  <li>
   Competent in the use of retail CCTV systems.
  </li>
  <li>
   Loss Prevention Investigative Interview Training.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Minimum Education
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   The knowledge, skills and abilities typically acquired through the completion of a high school diploma and/or GED.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Education
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   No additional education
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Minimum Years Of Work Experience
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   3
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Years Of Work Experience
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   No additional years of experience
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Minimum Leadership Experience
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   None
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Leadership Experience
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   None
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Certifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   None
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Competencies
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   None
  </li>
 </ul>
</div>


Central Investigator

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Central Investigator