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case manager 10237

Morgan & Morgan

<div><div>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.</div>
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'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've found that being in the office helps new team members get up to speed quickly and feel more connected.

#LI-FW1<div>
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. For full-time employees, we offer an excellent benefits package including medical and dental insurance, 401(k) plan, 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.
Privacy Policy

Here is a link to Morgan &amp; Morgan's privacy policy.</div></div>

Case Manager

Civic Works

<div>Position title: Case Manager (Full-Time) 
Supervisory responsibilities: None 
Budget responsibilities: None 
Reports to: Student Services Manager 
FLSA Classification: Exempt 
Last updated: February 2026
Organization Summary
 
Founded in 1993, Civic Works strengthens communities through education, skills development and community service. Our Center for Sustainable Careers (CSC) includes our Career Pathways and Career Exploration (YouthBuild) workforce development programs.
The Civic Works YouthBuild program engages Baltimore City youth and young adults, between the ages of 16-24, to complete their high school education while earning construction industry-related skills certifications, training, and work experience. Students help construct housing for low-income families and develop leadership, job readiness, and academic skills to support pathways to full-time employment paying a family-sustaining wage. The program offers intensive wrap-around support services to help participants address barriers to success and achieve their education and career goals.
Position Summary 
Join us as a Case Manager and make a lasting impact on the lives of our participants. You will provide consistent support, advocacy, guidance, and assistance to help participants overcome personal, legal, and social obstacles on their path to success. Your role will involve implementing and managing Individual Service and Support Plans, tailoring your approach to each participant's unique needs. Through your case management services, you will help individuals navigate challenges and achieve their career aspirations.
Primary Responsibilities:
1. Case Management Services
<ul><li>Provide comprehensive case management services to program participants.
</li><li>Conduct pre-enrollment intake assessments to inform case management and goal development.</li><li>
Conduct one-on-one meetings with program participants to assess and create Individual Service and Support Plans (ISS), as well as short and long-term case plan development.</li><li>
Provide direct support, guidance, and advocacy to help participants achieve their goals, including obtaining a valid driver's license and vehicle, addressing legal concerns, meeting basic needs, developing financial stability, fostering resilience and positive social skills, and promoting workplace readiness.</li><li>
Coordinate group sessions on topics such as harm reduction, parenting, budgeting, and anger management.</li><li>
Advocate for program participants as needed, providing necessary follow-up support.</li></ul>
2. Partnerships<ul><li>
Establish and nurture partnerships with service providers/organizations offering resources in areas such as housing, finance, education, medical care, substance abuse prevention, and counseling.
</li><li>Make referrals to external organizations for housing, financial, education, medical, and counseling services.</li></ul>
3. Tracking Participant Progress and Documentation<ul><li>
Track and support participants' progress on their ISS throughout enrollment and for at least twelve (12) months following their exit.
</li><li>Collaborate with program staff, providing regular reports on participants' ISS case status.
</li><li>Maintain accurate and up-to-date case files for program participants, collecting, verifying, and updating relevant information.
</li><li>Document all interactions with participants through detailed daily case notes, ensuring compliance with grant requirements.
</li></ul>Secondary Responsibilities:<ul><li>
Collaborate with staff to ensure participant feedback is included in planning for future outreach and program growth.</li><li>
Conduct periodic reviews and audits of records to ensure compliance with grant requirements.</li></ul>
Education and Experience:<ul><li>
Bachelor's degree in a related field. Experience may be substituted for this requirement.
</li><li>Minimum of two (2) years direct service/case management experience.
</li><li>Strong computer, organization, and note-taking skills required, with experience using Google Sheets, Docs, and online database systems programs.
</li><li>Knowledge of community resources and referral process, particularly in Baltimore City.</li><li>
Valid driver&rsquo;s license.
</li></ul>Skills and Abilities:<ul><li>
Ability to establish and maintain effective counseling relationships with program participants.</li><li>
Ability to engage in self-care and prioritize healthy workplace boundaries.
</li><li>Highly organized, detail-oriented, and able to manage multiple projects simultaneously.
</li><li>Ability to work independently under pressure and tight deadlines.
</li><li>Excellent verbal communication skills, interpersonal relations skills, and writing skills.
</li><li>Ability to recognize problems, develop innovative solutions and implement them.
</li><li>Ability to adhere to a strict guideline of keeping and maintaining confidential information.
</li><li>Ability to prepare and submit accurate and reliable reports.
</li></ul>Work Environment &amp; Physical Demands:<ul><li>
Work schedule is typically Monday-Friday (8am-4:30pm).</li><li>
Regular local travel for participant case management appointments and meetings with external partners.</li><li>
The position will be fully in-person, 5 days per week.</li></ul>
Benefits: 
Eligible for benefits, including but not limited to medical insurance, dental and vision insurance, long term and short term disability, life insurance, 401(k) plan with employer match, and paid time off.</div>

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>

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)

Catholic Charities of Baltimore

<div>Pay rate: Starting at $51,200

Catholic Charities is seeking a Case Manager in the Weinberg Housing and Resource Center. The Case Manager assesses household needs, coordinates resources based on goals, and provides advocacy, information, and referral services. The work schedule Saturday-Wednesday 9 AM - 5 PM.

The Weinberg Housing and Resource Center (WHRC) houses individuals faced with challenges including mental health and substance use issues. Individuals present on a frequent basis with crisis needs related to trauma, mental health, addiction, and housing.
JOB DUTIES &amp; RESPONSIBILITIES:
<ul>
<li>Work with clients to primarily focus on improving quality of life in obtaining stable and permanent housing, goal setting, case planning and personal development</li>
<li>Maintain casework files on each client according to policies and procedures and organize and record information into ETO and HMIS in a timely manner</li>
<li>Provide support, advocacy, information and referral services to Clients of Sarah's House</li>
<li>Participate in and accurate track case management progress for 30/60/90 team meetings in HMIS</li>
<li>Motivate and empower clients to establish and reach goals, including obtaining information from clients such as: client&rsquo;s interests, aptitudes, and abilities for developing case plans</li>
<li>Ensures client confidentiality is maintained in accordance with HMIS guidelines and requirements.</li>
<li>Other duties as assigned.</li>
</ul>
Program Specific Duties:

WHRC:
<ul>
<li>Crisis Prevention Services:
<ul><li>Provide crisis management services to clients to promote stability and referral to appropriate resources.</li>
<li>Coordinate with team members on difficult clients including making recommendations for ongoing services.</li>
<li>Assist individuals with crisis needs related to trauma, mental health, addiction, and housing.</li>
<li>Assist in helping clients navigate through intense feelings while providing an anchor in reality.</li>
</ul></li><li>Housing Services:
<ul><li>Ensures compliance with the U.S. Department of Housing and Urban Development (HUD) rules and regulations and passing annual HUD audits and other privately funded programs.</li>
<li>Coordinates housing leased to or for clients, negotiates leases with the landlords and occupancy agreements with residents; maintains ongoing contact with realty representatives and property managers to ensure good relations.</li>
<li>Inspects the property and/or apartments at specific intervals.</li>
<li>Reinforces occupancy policies and procedures by initiating procedures for non-payment of rent.</li>
<li>Monitors the upkeep of the property, including snow &amp; trash removal, landscaping, and routine maintenance and repairs.</li>
</ul>
</li></ul>Education &amp; Experience Requirements:

Case Manager:
<ul>
<li>Bachelor's degree in Human Services, Social Work, or related field.</li>
<li>Two years related experience.</li>
<li>Excellent knowledge of case management and crisis intervention services.</li>
<li>An equivalent combination of education and experience may be considered.</li>
</ul>
Senior Case Manager:
<ul>
<li>Master's degree in Human Services, Social Work or related field.</li>
<li>Five years of related experience.</li>
<li>Excellent knowledge of case management and crisis intervention services.</li>
</ul>
Required Skills &amp; Abilities:
<ul>
<li>Demonstrates patience and composure when working with others, fostering positive relationships.</li>
<li>Exhibits exceptional relational and customer service skills, building strong connections and providing top tier service.</li>
<li>Acts with discretion, tact, and professionalism in all situations, maintaining confidentiality and integrity.</li>
<li>Demonstrates excellent verbal and written communication skills, ensuring clear and effective exchanges.</li>
<li>Displays excellent organizational skills and attention to detail, ensuring accuracy and efficiency.</li>
<li>Utilizes effective conflict resolution skills to address issues and maintain a positive environment.</li>
<li>Requires proficiency in using computer systems and software to perform job function, including but not limited to, basic Windows PC, web browsing (i.e., Chrome, Internet Explorer, etc.), and Microsoft Outlook. Knowledge of other Microsoft Office applications, such as Word, Excel PowerPoint, Teams, and OneDrive is preferred.</li>
</ul>
Physical Requirements &amp; Work Environment:
<ul>
<li>No remote or hybrid work availability based on core and essential functions of the position.</li>
<li>Remaining in a stationary position, which may involve standing or sitting for extended periods, as required to complete tasks or duties associated with the role.</li>
<li>Moving about to accomplish tasks or transitioning between different work sites, which may involve walking, standing, or traveling to various locations as required by the role.</li>
<li>Engaging in communication with others to exchange information, which may involve speaking, listening, writing, or using electronic communication methods to ensure clear and effective understanding. This includes both verbal and non-verbal interactions with colleagues, clients, or external parties.</li>
<li>Repetitive motions involving the wrists, hands, and/or fingers, including tasks such as typing, data entry, or handling small objects. These repetitive activities may occur throughout the workday and require attention to ergonomics to ensure comfort and minimize strain.</li>
<li>Assessing the accuracy, neatness, and completeness of assigned work to ensure it meets quality standards and adheres to established guidelines.</li>
<li>Hearing and vision abilities, with or without correction, sufficient to drive safely and effectively observe and communicate with others.</li>
</ul>
We offer a wide range of benefits to meet the ever-changing needs of our employees including but not limited to:
<ul>
<li>Health/Dental/Vision</li>
<li>Vacation/sick/holiday pay</li>
<li>403(b) Retirement Plan with a discretionary employer contribution</li>
<li>Tuition Advancement</li>
<li>Paid Parental Leave</li>
</ul>
Join Catholic Charities of Baltimore where you will be an important member of a trauma-informed care organization that promotes a culture of safety, empowerment, healing, and self-care, and that believes that every person has infinite worth and promise.

Catholic Charities is an equal opportunity employer</div>

Case Manager / Sr. Case Manager- WHRC

CareFirst BlueCross BlueShield

<div>Resp &amp; Qualifications
PURPOSE:
 
The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and regulations that govern the appeal process for Commercial and lines of business in order to formulate a professional response to the appeal request. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. 
 
ESSENTIAL FUNCTIONS:<ul><li>
Investigates, interprets, and analyzes written appeals and reconsideration requests from multiple sources including applicants, subscribers, attorneys, group administrators, internal stake holders and any other initiators. Responds to such requests with original letters, complex and technical in nature, upholding corporate policies and decisions while meeting all State and Federal regulations and mandates.</li><li>
Organizes the appeal case for physician review by compiling clinical, contractual, medical policy and claims information along with corporate and appellant correspondence. Formulates recommendations for disposition. Prepares the written case for review and, following the physician review, communicates the final decision to the member and providers including an explanation of the final decision and all External appeal rights.</li><li>
Investigates, interprets, analyzes and prioritizes appeal requests using nursing expert knowledge and all available clinical information for both medical and behavioral health conditions, as well as medical policies, to determine if the adverse coverage and adverse decisions are appropriate. Interpret and apply, as appropriate Regulatory and accreditation requirements. Collaborates with Independent Review Organizations and contracted Panel Physicians in obtaining clinical opinions from physician specialists, to determine if adverse decisions are appropriate. Interacts and responds to complaints from Regulatory Agencies and CMS.</li><li>
Maintains a ready command of a continuously expanding knowledge base of current medical practices and procedures, including current medical, mental health and substance abuse/addiction procedural terminology, surgical procedures, dental procedures, diagnostic entities and their complications.
</li></ul>QUALIFICATIONS: 
 
Education Level: High School Diploma or GED.
Licenses/Certifications:<ul><li>
RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon Hire Required</li><li>
CCM - Certified Case Manager Upon Hire Preferred</li><li>
LNCC - Legal Nurse Consultant Certified Upon Hire Preferred</li></ul>
Experience:
<ul><li>2 years medical-surgical or similar clinical experience OR</li><li>
3 years experience in mental health, psychiatric setting</li></ul>
Preferred Qualifications:<ul><li>
2 years experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross BlueShield, and/or previous experience in a healthcare payor organization working with clinical appeals and grievances.
</li><li>BSN/MSN Degree
</li></ul>Knowledge, Skills and Abilities (KSAs)<ul><li>
Knowledge and understanding of medical terminology.</li><li>
Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used in processing appeals.</li><li>
Excellent verbal and written communication skills, strong listening skills, critical thinking and analytical skills, problem solving skills, ability to set priorities and multi-task.</li><li>
Ability to effectively communicate and provide positive customer service to every internal and external customer.</li><li>
Knowledge of Microsoft Office programs.</li><li>
Excellent analytical and problem-solving skills to assess the medical necessity and appropriateness of patient care and treatment on a case-by-case basis, including issues pertaining to members with mental health treatment needs or those with substance disorders and addictions.</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>
</li></ul>Salary Range: $67,320 - $133,705 
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
Clinical Appeals and Analysis
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
#LI-SS1</div>

Clinical Appeals Nurse (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>

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