medical management coordinator i (remote)

case manager

case manager (10237)

marketing manager

medical management coordinator i (remote) Jobs in Baltimore

case management manager

Morgan & Morgan, P.A.

<div>
 
 
 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.
 
 
 
 
 Summary
 
 
 
 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.
 
 
 
 Responsibilities
 
 
 <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>
 
 
 Qualification
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree (preferred)
 </li>
 <li>
 Prior experience as a Personal Injury Case Manager preferred
 </li>
 <li>
 2+ years of working as an insurance adjuster or pre-litigation paralegal
 </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>
 
 
 This role is on-site, which gives you the chance to be fully immersed in the work and gain direct experience alongside the team. We&rsquo;ve found that being in the office helps new team members get up to speed quickly and feel more connected.
 
 
 
 
 
 
 
 Salary range: $60,000 USD - $90,000 USD
 
 
 
 Benefits
 
 
 
 
 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.
 
 
 
 
 Equal Opportunity Statement
 
 
 
 
 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.
 
 
 
 
 E-Verify
 
 
 
 
 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;
 
 
 
 
 Privacy Policy
 
 
 
 
 Here is a link to Morgan &amp; Morgan's privacy policy.
 
 
</div>

Case Manager

Baltimore Crisis Response, Inc

Description
 <div>Case Manager
 Baltimore, Maryland
 $20.00-$23.00 Hourly
 Full-Time | Shifts: 8:00M-4:00PM | Monday- Friday
Being the Leader Communities Need in Moments of Crisis.
About Us
Baltimore Crisis Response, Inc. (BCRI) is a nationally recognized nonprofit and Baltimore&rsquo;s only comprehensive crisis response system. Since 1992, we&rsquo;ve been at the forefront of behavioral health crisis care &mdash; providing timely, community-based services for individuals and families experiencing mental health and substance use challenges.
The Opportunity
We are seeking a Case Manager to support individuals as they move through different levels of care. In this role, you&rsquo;ll partner with clients and their care teams to coordinate services, develop discharge plans, and connect individuals with the community resources they need for ongoing recovery. You&rsquo;ll also play a hands-on role in monitoring daily progress, supporting treatment goals, and fostering smooth transitions across the system of care.
This is more than case coordination &mdash; it&rsquo;s an opportunity to advocate for individuals, strengthen continuity of care, and make a meaningful impact on recovery outcomes in Baltimore. 
What You&rsquo;ll Do
<ul><li>Supports the delivery of care and engagement of individuals under care by participating in group supervision and by reviewing evaluations, assessments, treatment plans, and progress notes to understand the unique needs, strengths, preferences, and goals.
</li><li>Assesses the needs of the individual receiving care across multiple domains including mental health, medical, social, and other services by completing needs assessment and other appropriate tools.
</li><li>Partners with the client receiving care and their care team to identify clinical goals, interventions, and strategies, documenting in the discharge plan.
</li><li>Initiates and submits referrals to medical and Behavorial health care, community programs, and service providers.
</li><li>Develops and maintains strong working knowledge of care partners, service providers, and stakeholders across the system of care, maintaining a positive rapport.
</li><li>As approved and assigned, uses company vehicles to provide transportation for individuals entering, receiving, or discharged from care.
</li><li>Collaborates with care team members for admission and discharge from the residential milieu, engaging external stakeholders when appropriate and as directed during these transitions.
</li><li>Serves as a liaison as assigned and appropriate for internal and external stakeholders, care partners, and visitors.
</li><li>Demonstrates adherence to company policies, expectations, and behavioral competencies, both explicit and implicit.
</li><li>All tasks, projects, and/or duties as assigned and authorized, as determined by Direct Supervisor (or designated delegate) to be congruent with the role.</li></ul></div>
 Qualifications
 <div>Qualifications
<ul><li>High school diploma or equivalent.
</li><li>Bachelor&rsquo;s Degree preferred
</li></ul>Additional
<ul><li>Applicant must have a valid MD driver&rsquo;s license and will transport clients using a company vehicle when needed.
</li></ul>Why Join BCRI
 Medical, Dental, and Vision Insurance.
 403(b) Retirement Plan
 Generous PTO &ndash; Vacation, Sick, Personal, and Holidays.
 Tuition Reimbursement &amp; Professional Development Support.
 Be part of an innovative, impact-driven team shaping the future of crisis care.
Make a Difference. Lead with Compassion.
 
This is more than a leadership role &mdash; it&rsquo;s a chance to help individuals and families find stability in their most vulnerable moments.
 Apply today and become a guiding force for change.</div>

Case Manager (10237)

<div>Case Manager
 Baltimore, Maryland 
 $20.00-$23.00 Hourly
 Full-Time | Shifts: 8:00M-4:00PM | Monday- Friday
Being the Leader Communities Need in Moments of Crisis.
About Us
Baltimore Crisis Response, Inc. (BCRI) is a nationally recognized nonprofit and Baltimore&rsquo;s only comprehensive crisis response system. Since 1992, we&rsquo;ve been at the forefront of behavioral health crisis care &mdash; providing timely, community-based services for individuals and families experiencing mental health and substance use challenges.
The Opportunity
We are seeking a Case Manager to support individuals as they move through different levels of care. In this role, you&rsquo;ll partner with clients and their care teams to coordinate services, develop discharge plans, and connect individuals with the community resources they need for ongoing recovery. You&rsquo;ll also play a hands-on role in monitoring daily progress, supporting treatment goals, and fostering smooth transitions across the system of care.
This is more than case coordination &mdash; it&rsquo;s an opportunity to advocate for individuals, strengthen continuity of care, and make a meaningful impact on recovery outcomes in Baltimore.
What You&rsquo;ll Do<ul><li>
Supports the delivery of care and engagement of individuals under care by participating in group supervision and by reviewing evaluations, assessments, treatment plans, and progress notes to understand the unique needs, strengths, preferences, and goals.
</li><li>Assesses the needs of the individual receiving care across multiple domains including mental health, medical, social, and other services by completing needs assessment and other appropriate tools.
</li><li>Partners with the client receiving care and their care team to identify clinical goals, interventions, and strategies, documenting in the discharge plan.
</li><li>Initiates and submits referrals to medical and Behavorial health care, community programs, and service providers.
</li><li>Develops and maintains strong working knowledge of care partners, service providers, and stakeholders across the system of care, maintaining a positive rapport.
</li><li>As approved and assigned, uses company vehicles to provide transportation for individuals entering, receiving, or discharged from care.
</li><li>Collaborates with care team members for admission and discharge from the residential milieu, engaging external stakeholders when appropriate and as directed during these transitions.
</li><li>Serves as a liaison as assigned and appropriate for internal and external stakeholders, care partners, and visitors.
</li><li>Demonstrates adherence to company policies, expectations, and behavioral competencies, both explicit and implicit.
</li><li>All tasks, projects, and/or duties as assigned and authorized, as determined by Direct Supervisor (or designated delegate) to be congruent with the role.
</li></ul>Qualifications<ul><li>
High school diploma or equivalent.
</li><li>Bachelor&rsquo;s Degree preferred
</li></ul>Additional<ul><li>
Applicant must have a valid MD driver&rsquo;s license and will transport clients using a company vehicle when needed.</li></ul>
Why Join BCRI 
 Medical, Dental, and Vision Insurance. 
 403(b) Retirement Plan 
 Generous PTO &ndash; Vacation, Sick, Personal, and Holidays. 
 Tuition Reimbursement &amp; Professional Development Support. 
 Be part of an innovative, impact-driven team shaping the future of crisis care.
Make a Difference. Lead with Compassion. 
This is more than a leadership role &mdash; it&rsquo;s a chance to help individuals and families find stability in their most vulnerable moments.
 Apply today and become a guiding force for change.</div>

Living Classrooms Foundation

<div><h6 class="jobSectionHeader">Outreach Resource Navigator</h6>
Outreach Resource Navigator will work individually and as a team to provide resource links to community residents who have been directly impacted by violence. The Outreach Resource Navigator&rsquo;s mission will be to encourage communication, understanding and help foster a stronger healthier neighborhood. The Outreach Resource Navigator reports to the Outreach Resource Navigator Supervisor.<h6 class="jobSectionHeader">
Essential Functions: 
Primary Responsibilities
</h6><ul><li>Identifies individuals in program area who have been impacted by violence or are at the highest risk for involvement in violence, from spending time in the community.</li><li>Establishes contact with vulnerable individuals and developing relationships, imparting messages rejecting unhealthy behavior, and working to change behaviors by recruiting,</li></ul>
selecting, training, and supporting.
<ul><li>Establishes a caseload of participants who agree to be part of the program (typically 5 to 7) within the first 6 months of work.</li><li>For each participant, conduct an assessment and work with case management team in developing a strategic life plan for reducing the participant&rsquo;s risk and shifting their behavior.</li><li>Meets with participants several times a week, including at critical times of need, developing a relationship, and working to change behaviors through specific messaging designed to address issues faced by the participant.</li><li>Assists participants with barrier removal &ndash; such as education, employment, criminal justice, mental health, substance use, trauma, reentry, and related life skills &ndash; through the utilization of existing internal and external partnerships.</li><li>Formulates and regularly updates (daily, weekly, and quarterly) a plan of action that identifies a strategy for gathering information and assessing its accuracy and use.</li><li>Attends weekly staff meetings and regular supervisor reviews.
</li><li>Ensures continuous monitoring and improvement of the quality of community outreach, engagement, and interventions.</li><li>Participates in meetings and other internal processes.
</li><li>Reports to Program Director on the performance outcomes.
</li><li>Ensures consistent quality, customer service and professionalism.
</li><li>Commitment to continuous learning, and willing to share and cascade this learning to the team.
</li><li>Maintains credibility and access to the highest risk without undue confusion as to job role.</li></ul>
Data Entry<ul><li>Maintains appropriate and specific program data records to document services provided to program participants in the Birdseye Case Management System.</li><li>Update and manage program data in the Birdseye Case Management System.
</li><li>Track all program participants for one year, including individual case notes, employment retention and other data as deemed required by program administrators.</li></ul>
Administrative<ul><li>Perform basic keyboarding functions.
</li><li>Facilitates intake of new program participants with the programs case management and social worker team</li><li>Works in a professional manner under sometimes extremely stressful situations
</li><li>Pay close attention to detail and recordkeeping to maintain accurate records.
</li><li>Commitment to following approved standards, guidelines, policies, and procedures.
</li><li>Interacts in a professional manner with many personalities and attitudes and with people from many diverse backgrounds.</li><li>Respects and protects rights and confidentiality without regard to personal beliefs and judgments.</li><li>Accurately utilize all resource material available to remain current in the profession, including attending departmental in-service training</li></ul>
 &bull; The Outreach Navigator must be willing to work as a team to meet LCF's Workforce Development mission, objectives, and yearly goals.<ul><li>A commitment to honesty and integrity in performing all duties is required.
</li><li>Proactive approach to all aspects of the job, taking responsibility for the continuous improvement and development of a first-class community centered service.</li><li>Empathizes with clients, staff, volunteers, colleagues, and partner agencies, and a commitment to put clients first when making decisions.</li><li>Ability to work effectively with people of diverse educational and cultural backgrounds, from justice-involved individuals to the general public.</li><li>Attends community meetings or community events to understand community issues and build relationships with community members.</li><li>Distributes flyers, brochures or other informational or educational documents to inform members of a specific community.</li><li>Works calmly and efficiently in a fast-paced, stressful environment.
</li><li>Maintains calm during emergency situations.
</li><li>Accepts feedback from others</li></ul></div>

Outreach Resource Navigator

CGS Federal (Contact Government Services)

<div>
 Paralegal
 
 
 Employment Type: Full-Time, Mid-Level
 
 
 Department: Legal
 
 
 CGS is seeking a dedicated Paralegal to join a fast-paced and hard-working team to assist with any legal accounts. As a Paralegal, you will play a key role in supporting various aspects of the company's portfolio.
 
 
 CGS brings motivated, highly skilled, and creative people together to solve the government&rsquo;s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities.
 
 
 Skills and attributes for success:
 
 
 
 <ul>
 <li>
 The Contractor shall provide professional, accurate, timely, and reliable paralegal support reporting to the OGC and will be detailed to assist LITB or IALB. Work products are reviewed prior to submission; however, personnel resources provided by Contractor shall often develop these products with minimal direct supervision other than written guidelines. Personnel assigned to this task must have the ability to adjust to changing priorities and work well under pressure
 </li>
 <li>
 The General Paralegal Task includes but is not limited to the following:
 </li>
 <li>
 Contractor shall receive, prioritize, and process requests such as document review or requests for advice or legal technical assistance;
 </li>
 <li>
 Contractor shall research and locate responsive information documents and identify relevant laws, judicial decisions, and legal articles;
 </li>
 <li>
 Contractor shall perform typical Paralegal functions, including: moderately complex legal research; synopsizing transcripts of hearings and oral arguments for attorney use; reviewing case related materials; and identifying potentially conflicting statements or areas requiring further investigation;
 </li>
 <li>
 Contractor shall write preliminary drafts of legal memoranda and correspondence;
 </li>
 <li>
 Contractor shall assist in preparing draft legal documents, such as motions, briefs, memoranda of law, exhibits, etc.; conducting legal analysis, reviewing documents for relevance and privilege; and assisting attorneys with all phases of litigation;
 </li>
 <li>
 Contractor shall review materials in discovery for relevancy and privilege;
 </li>
 <li>
 Contractor shall prepare privilege logs;
 </li>
 <li>
 Contractor shall maintain documentation of records produced in discovery, correspondence sent, and case management functions performed;
 </li>
 <li>
 Contractor shall assist in the drafting and issuing of preservation notices and litigation holds;
 </li>
 <li>
 Contractor shall design, generate, and transmit reports regarding case assignments and productivity using case management databases
 </li>
 <li>
 Contractor shall analyze and interpret requests from customers;
 </li>
 <li>
 Contractor shall research, locate, and gather material relevant to DU requests including conducting outreach and informal interviews to respond to discovery requests and interrogatories;
 </li>
 <li>
 Contractor shall assist in preparation of declarations;
 </li>
 <li>
 Contractor shall scan paper materials to save as an image file (e.g., .PDF);
 </li>
 <li>
 Contractor shall conduct legal privilege reviews using Veritas eDiscovery Platform, Adobe Pro, or other discovery review platforms provided by the FBI;
 </li>
 <li>
 Contractor shall analyze documents and media files, and proficiently apply redactions to diverse types of privileged information;
 </li>
 <li>
 Contractor shall review the work of peers for accuracy and provide constructive edits to ensure quality and thoroughness of review and processing;
 </li>
 <li>
 Contractor shall support and collaborate the management efforts to foster teamwork, planning and decision making;
 </li>
 <li>
 Contractor shall organize and maintain accurate records of assigned requests. This includes keeping detailed case notes, utilizing discovery work plans, using Microsoft Excel spreadsheets, and entering case information and metrics into the OGC-LITB case tracking database;
 </li>
 <li>
 Contractor shall prepare electronic and/or paper releases for release to customers;
 </li>
 <li>
 Contractor shall provide a high degree of professionalism and customer service in all interactions with DU customers;
 </li>
 <li>
 Contractor shall prioritize and schedule projects to accomplish objectives;
 </li>
 <li>
 Contractor shall assist in representation efforts of the FBI in challenging situations;
 </li>
 <li>
 Contractor shall coordinate classification reviews with subject matter experts and shall perform overlays of material returned from classification review;
 </li>
 <li>
 Contractor shall maintain close collaboration of projects with discovery team members;
 </li>
 <li>
 Contractor shall serve as consultant to Government employees regarding privilege application and document production;
 </li>
 <li>
 Contractor shall communicate with employees at all levels of the FBI to complete projects with a high degree of professionalism;
 </li>
 <li>
 Contractor shall provide weekly statuses to management and periodic updates to Assistant General Counsels and other DU customers;
 </li>
 <li>
 Contractor shall conduct searches of FBI systems and databases to retrieve relevant documents or files (e.g., Sentinel, Internal Policy Office Policy Library and Policy Archives);
 </li>
 <li>
 Contractor will perform legal and other research, provide support to the Legal Hold program as well as the Freeze List, and support tasks associated with information management/governance as well as technology and its intersection with the law to name a few
 
 
 
 
 
 </li>
 </ul>
 Qualifications:
 
 
 
 <ul>
 <li>
 Requires paralegal certificate, or JD, or currently attending an ABA-accredited law school, having completed at least one year of study
 </li>
 <li>
 At least two years of litigation paralegal experience is required; trial experience is very helpful
 </li>
 <li>
 At least one year of experience in automated litigation support. Requires sound working knowledge of federal and state court systems, legal research procedures, and legal research resources
 </li>
 <li>
 Requires excellent written and oral communication skills and thorough knowledge of legal research tools such as LEXIS and Westlaw
 </li>
 <li>
 Must have hands-on familiarity with a variety of computer applications, including word processing, databases (such as document review and file management systems), spreadsheets, imaging, and hardware systems
 </li>
 <li>
 Role also requires hands-on familiarity with ESI tools and knowledge of eDiscovery procedures and resources
 </li>
 <li>
 The ability to consistently deliver the highest quality work under extreme pressure will be very important
 
 
 
 
 
 </li>
 </ul>
 Our Commitment:
 
 
 Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client&rsquo;s specific needs. We are committed to solving the most challenging and dynamic problems.
 
 
 For the past seven years, we&rsquo;ve been growing our government-contracting portfolio, and along the way, we&rsquo;ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work.
 
 
 Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come.
 
 
 We care about our employees. Therefore, we offer a comprehensive benefits package.
 
 
 
 <ul>
 <li>
 Health, Dental, and Vision
 </li>
 <li>
 Life Insurance
 </li>
 <li>
 401k
 </li>
 <li>
 Flexible Spending Account (Health, Dependent Care, and Commuter)
 </li>
 <li>
 Paid Time Off and Observance of State/Federal Holidays
 
 
 
 
 
 </li>
 </ul>
 Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
 
 
 Join our team and become part of government innovation!
 
 
 Explore additional job opportunities with CGS on our Job Board:
 
 
 https://cgsfederal.com/join-our-team/
 
 
 For more information about CGS please visit: https://www.cgsfederal.com or contact:
 
 
 Phone: +1 (888) 680-5916Email: info@cgsfederal.com
 
 
 #CJ
 
 
 We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
</div>

Paralegal (Top Secret Clearance Required)

CareFirst BlueCross BlueShield

<div>
 
 Resp &amp; Qualifications
 
 
 
 
 PURPOSE:
 
 
 
 The Clinical Navigator (RN) conducts concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in both care management and utilization management, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care, and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working telephonically with the hospital care team including case managers, social workers and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge. The candidate may be required to come to the CareFirst office location periodically for meetings, training, or other business-related activities. The candidate's primary residence must be within the
 
 greater Baltimore metropolitan area
 
 . Bilingual - fluent in Spanish a big plus!
 
 
 
 Essential Functions
 
 
 
 <ul>
 <li>
 Utilize clinical expertise and critical thinking skills to analyze available clinical information, Electronic Medical Records (EMRs), benefit contracts, mandates, medical policy, evidence based published research, national accreditation and regulatory requirements to aid in determination of appropriateness and authorization of inpatient clinical services. Engages telephonically with member, family and providers to identify key strategic interventions, discharge planning and coordination to address members medical, behavioral and/or social determinant of health needs to promote a safe transition to the appropriate level of care and/or home.
 </li>
 <li>
 Collaborates with CareFirst medical directors and participates in internal case rounds/discussions to determine appropriate course of action and level of care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with benefit determination.
 </li>
 <li>
 Makes referrals to other care management programs as appropriate for chronic, long-term care coordination.
 </li>
 <li>
 Works collaboratively with hospital teams to develop positive working relationships to decrease provider abrasion and improve the member experience.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Education Level:
 
 Bachelor's Degree in Nursing OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
 
 
 
 Licenses/Certifications Upon Hire Required
 
 
 
 <ul>
 <li>
 RN - Registered Nurse - State Licensure And/or Compact State Licensure: RN - Registered Nurse in MD, VA or Washington, DC
 
 
 </li>
 </ul>
 
 Experience:
 
 5 years clinically related experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review.
 
 
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Knowledge and experience with MCG
 </li>
 <li>
 Experience working with Commercial and Medicare/Medicaid enrollees and benefits contracts
 </li>
 <li>
 CCM certification
 </li>
 <li>
 MCG certification
 
 
 </li>
 </ul>
 
 Knowledge, Skills And Abilities (KSAs)
 
 
 
 <ul>
 <li>
 Strong interpersonal skills and the ability to engage in a member facing environment telephonically while at the same time building relationships and partnerships with hospital care team and alternative care delivery partners to meeting member/enrollee needs.
 </li>
 <li>
 Strong clinical documentation skills along with the ability to type on a computer keyboard with ease and speed.
 </li>
 <li>
 Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and Power Point.
 </li>
 <li>
 Strong analytical and problem-solving skills to judge appropriateness of member services and treatments on a case-by-case basis.
 </li>
 <li>
 Knowledge of clinical standards of care and disease process and national, evidence based clinical guidelines and hospital operations.
 </li>
 <li>
 Knowledge of available community resources and programs.
 </li>
 <li>
 Basic understanding of the strategic and financial goals of a health care system, payer organization, health plan and/or health insurance operations (e.g. networks, eligibility, benefits).
 </li>
 <li>
 Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
 
 
 </li>
 </ul>
 
 Salary Range:
 
 $72,216 - $143,429
 
 
 
 Salary Range Disclaimer
 
 
 
 The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
 
 
 
 Department
 
 
 
 Maryland Inpatient Telephonic
 
 
 
 Equal Employment Opportunity
 
 
 
 CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
 
 
 
 Where To Apply
 
 
 
 Please visit our website to apply: www.carefirst.com/careers
 
 
 
 Federal Disc/Physical Demand
 
 
 
 Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
 
 
 
 Physical Demands
 
 
 
 The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
 
 
 
 Sponsorship in US
 
 
 
 Must be eligible to work in the U.S. without Sponsorship
 
 
</div>

Clinical Navigator (Remote)

Evergreen Nephrology

<div>Who You Are

You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You're excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change.
Who We Are

Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.

We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients.

We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.

Your Role

As a Nurse Care Manager with Evergreen Nephrology, you are responsible for managing an assigned patient panel and addressing each patient's specialized needs based on their individual conditions, healthcare needs, goals, and wishes. You will collaborate with a team of physicians, Advanced Practice Providers (APPs), and Interdisciplinary Team (IDT) members. Nurse Care Managers at Evergreen often focus on patients targeted for specific programs such as Chronic Complex Care Management, Compassionate Care Management, Post Acute Care, Transitions of Care, and CKD Management.
While our Nurse Care Manager positions are fully remote, this specific position will support patients in the Eastern Time Zone and must be able to work 8:30a - 5p EST.
Role Responsibilities

Some responsibilities may vary based on specific patient programs, but this role's primary duties include the following:
<ul>
<li>Managing the overall care management of patient panel by leveraging experience, expertise, and knowledge in both the nursing field and value-based care operations.</li>
</ul><ul><li>Establishing trusting and empathetic relationships with patients and families to provide clinical and emotional support and foster collaboration throughout their care journey.</li>
</ul><ul><li>Serving as an advocate and community liaison for patients to ensure proper and timely resources and support while navigating the health care system and maintaining compliance with the primary care team's/nephrologist's treatment plan.</li>
</ul><ul><li>Performing assessments and identifying the needs, including social determinants of health, of panel patients and caregivers based on values, care goals, and individual preferences, and translating these into patient-centric actionable care plans through comprehensive evaluations.</li>
</ul><ul><li>Coordinating the interdisciplinary approach to achieving continuity of care and reducing fragmentation, focusing on kidney disease progression management, utilization management, and provider coordination through active care plan management.</li>
</ul><ul><li>Monitoring and evaluating the effectiveness of care management plans regularly, modifying interventions as necessary.</li>
</ul><ul><li>Following evidence-based care management guidelines and established workflow protocols to deliver high quality, efficient, patient-centered care that aligns with Evergreen's goals, quality metrics, and regulatory and payer requirements.</li>
</ul><ul><li>Collaborating with physician partners, community providers, APPs, and other clinical disciplines to create, implement, and manage integrated care plans.</li>
</ul><ul><li>Identifying cost-effective measures for patients that support value-based care goals of improving patient outcomes and quality while effectively managing resource utilization.</li>
</ul><ul><li>Facilitating patient and caregiver education on treatment options and empowering patients to make informed decisions about their care.</li>
</ul><ul><li>Supporting seamless transitions of care as patients move between care settings, proactively addressing potential barriers and collaborating with IDTs.</li>
</ul><ul><li>Actively participating in clinical huddles, and patient care conferences for patients under your care management as needed.</li>
</ul><ul><li>Engaging in continuous, organizational process improvement to identify opportunities for improvement and execute action plans to optimize care management workflows, patient engagement processes, customer/patient care efforts, and other protocols.</li>
</ul><ul><li>Preparing reports and other deliverables to communicate program changes or developments to appropriate stakeholders.</li>
</ul><ul><li>Collecting data to prepare and deliver reports alongside program leaders on program success, patient outcomes, and patient/caregiver satisfaction.</li>
</ul><ul><li>Other duties consistent with this role, as assigned.</li></ul> 


Required Qualifications
<ul>
<li>Associate degree in nursing
</li></ul><ul><li>Current RN License is required, Compact License preferred</li>
</ul><ul><li>Care management experience required</li>
</ul><ul><li>Certified Case Manager preferred</li>
</ul><ul><li>Intermediate skills with MS Office Suite of products including Outlook and Teams</li>
</ul><ul><li>Able to work effectively in a primarily remote environment:
<ul><li>Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended</li>
<li>Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role</li>
<li>Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information</li>
</ul>
</li></ul>Compensation

The pay range for this role is $90,000 to $103,000 annually. Exact pay is determined based on experience, education, demand for the role, and other role-specific factors. This role is also bonus eligible.
Benefits

Evergreen Nephrology's total rewards program is designed to support you in and outside of work. You can expect:
<ul>
<li>Paid time off starting at 4 weeks for full-time employees</li>
</ul><ul><li>12 paid holidays per year</li>
</ul><ul><li>Medical, dental, vision and life insurance, including an HSA with employer match</li>
</ul><ul><li>Reimbursement for continuing medical education for eligible roles</li>
</ul><ul><li>A 401(k) program where Evergreen matches up to 4% of contributions</li>
</ul><ul><li>Paid parental leave</li>
</ul><ul><li>A robust training and development program that starts with onboarding and continues throughout your career with Evergreen Nephrology</li></ul> 


Evergreen Nephrology is an equal opportunity employer. Applicants will not be discriminated against because of race, color, creed, sex, sexual orientation, gender identity or expression, age, religion, national origin, citizenship status, disability, ancestry, marital status, veteran status, medical condition or any other protected category under local, state or federal laws.

If you are an applicant with a disability who requires reasonable accommodation for any part of the hiring process, please contact us for assistance at recruiting@evergreennephrology.com.</div>

Nurse Care Manager - Eastern Time Zone

Explore 160+ Case management manager in Baltimore this March. Find roles across top companies and apply now to boost your career.

160 case management manager jobs In Baltimore

Case Manager

Case Manager (10237)

Case Manager

Outreach Resource Navigator

Paralegal (Top Secret Clearance Required)

Clinical Navigator (Remote)

Nurse Care Manager - Eastern Time Zone