healthcare case manager

WellVisor

Job Title: Case ManagerJob Summary: We are seeking a dedicated and compassionate Case Manager to join our team. The Case Manager will be responsible for coordinating and managing the care of patients in a remote setting. The ideal candidate will have strong organizational and communication skills, as well as a deep understanding of patient care.Duties: - Conduct comprehensive assessments of patients' needs and develop individualized care plans- Provide Utilization Management including prior authorization approvals - Collaborate with healthcare professionals to ensure the delivery of high-quality patient care - Coordinate and monitor patient progress throughout their healthcare journey - Advocate for patients' rights and ensure they receive appropriate medical treatment - Provide education and support to patients and their families regarding their medical conditions and treatment options - Assist in discharge planning and facilitate transitions of care - Maintain accurate and up-to-date documentation of patient interactions and interventionsQualifications: - Bachelor's degree in nursing - Current license as a registered nurse (RN) - Minimum of 3-5 years of experience in case management- Certified Case Manager preferred - Strong knowledge of medical terminology, disease processes, and treatment modalities - Excellent communication, interpersonal, and problem-solving skills - Ability to work independently and collaboratively within a multidisciplinary team - Proficient computer skills, including electronic medical record systemsBenefits: - Competitive salary based on experience - Professional development opportunitiesIf you are passionate about providing exceptional patient care and making a difference in people's lives, we encourage you to apply for the position of Case Manager. Please submit your resume and cover letter detailing your relevant experience and qualifications to cfran@wellvisor.com. We look forward to reviewing your application.Job Types: Contract, Part-timePay: $40.00 - $50.00 per hourSchedule:<ul><li>Monday to Friday</li></ul>Experience:<ul><li>Nursing: 3 years (Preferred)</li><li>Case management: 3 years (Preferred)</li></ul>License/Certification:<ul><li>RN (Required)</li></ul>Willingness to travel:<ul><li>25% (Preferred)</li></ul>Work Location: Remote

Nurse Case Manager

Vivent Health

<div>
 
 
 If you are currently employed at Vivent Health, please log into UKG and submit your application through the My Company/View Opportunities page.
 
 
 
 
 Get ready for something amazing! Imagine this: generous paid time off, including 12 paid holidays. And that&rsquo;s just the start of the incredible perks you&rsquo;ll enjoy at Vivent Health. There is 401k with 100% employer match up to 5%, 12 weeks of fully paid parental leave, employer subsidized medical, dental, vision benefits, and gender-affirming care benefits. And that's not even scratching the surface. Our complete package also includes employer paid short and long-term disability, tuition reimbursement, certification, and licensure assistance, and so much more. We also offer benefits for part-time roles!
 
 
 But here's the real deal. Your journey with Vivent Health isn't just a job. It's a chance to join an organization dedicated to fostering a workforce that reflects diverse backgrounds, perspectives, and experiences. This makes you a part of something bigger and enables you to have a meaningful impact in our communities and the lives of the amazing patients we serve.
 
 
 Here are a few highlights of what working at Vivent Health may offer you:
 
 
 <ul>
 <li>
 Equity Practices: Fair treatment, access, and opportunities for all employees, creating an environment where everyone feels valued, respected, and empowered to contribute.
 </li>
 <li>
 Professional Growth: Opportunities for professional development and advancement, along with training programs and events that promote cultural competence, unconscious bias training, and awareness.
 </li>
 <li>
 Collaboration on an inter-disciplinary team: Within our integrated HIV care and prevention model, we employ a high level of collaboration across disciplines. That means that, in your role, you will have the opportunity to be exposed to whole person-care across medical, behavioral health, pharmaceutical, research, and more!
 </li>
 <li>
 Delivery of quality patient care: Our integrated HIV care and prevention model is proven to help patients achieve positive health outcomes.
 
 
 </li>
 </ul>
 
 Your Contribution
 
 
 
 
 Deliver Excellence. Oversee with Integrity. Drive Progress. Exceed Expectations.
 
 
 
 The
 
 Case Manager
 
 will be an integral part of our healthcare team, providing comprehensive and compassionate case management services to clients. Your role involves collaborating with healthcare professionals and others as needed to address our clients&rsquo; medical, social, and emotional needs of our clients, ensuring they receive the highest quality of care.
 
 
 
 Our Expectations
 
 
 
 
 Winning skills and behaviors for success.
 
 
 
 
 Essential Job Duties
 
 
 
 <ul>
 <li>
 Works scheduled hours within the clinic setting as part of the internal care team, serving all Vivent patients seen in our clinic. Sometimes referred to as a Medical Case Manager.
 </li>
 <li>
 Conduct thorough assessments of clients' medical and psychosocial needs to develop individualized case management plans.
 </li>
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 Collaborate with healthcare providers to coordinate and facilitate access to medical services, ensuring a holistic approach to patient care.
 </li>
 <li>
 Perform eligibility assessments and collect eligibility proof documentation to facilitate access to grant funded services.
 </li>
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 Assist clients in accessing community resources, social services, support programs, and insurance coverage to enhance their overall well-being.
 </li>
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 Act as an advocate for clients within the healthcare system, ensuring their voices are heard and their needs are met.
 </li>
 <li>
 Provide timely and effective crisis intervention services, offering support to clients facing medical, social, or emotional challenges.
 </li>
 <li>
 Maintain accurate and up-to-date documentation of case management activities, adhering to organizational and regulatory standards.
 </li>
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 Work closely with interdisciplinary healthcare teams, including physicians, nurses, and mental health professionals, to achieve optimal health outcomes for clients.
 </li>
 <li>
 Provide health education and support to clients, empowering them to actively participate in managing their healthcare.
 </li>
 <li>
 Assist team members in coverage and assist other service lines when necessary (examples include food pantry, prevention, telehealth rooming, front desk).
 </li>
 <li>
 Other duties as assigned.
 </li>
 <li>
 Adherence to all agency policies, including Confidentiality, Employee Handbook, Health Care Corporate Compliance Plan, Standards of Conduct, and other relevant policies.
 
 
 </li>
 </ul>
 
 NOTE: Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.
 
 
 
 
 Knowledge Required
 
 
 
 
 Required and preferred knowledge and experiences to succeed.
 
 
 
 <ul>
 <li>
 Education:
 </li>
 <ul>
 <li>
 Bachelor&rsquo;s degree in Social Work, Psychology, or a related field.
 </li>
 </ul>
 <li>
 Work Experience:
 </li>
 <ul>
 <li>
 Previous experience in case management preferred.
 </li>
 <li>
 Experience working in healthcare and social service systems preferred.
 </li>
 <li>
 Valid Government Issued Driver&rsquo;s License required.
 </li>
 <li>
 Familiarity with coordinating and managing patient care plans, ensuring comprehensive and integrated services.
 </li>
 <li>
 Experience in providing effective crisis intervention services to individuals facing medical, social, or emotional challenges.
 </li>
 <li>
 HIV experience in a not-for-profit environment preferred.
 </li>
 </ul>
 <li>
 Technical Experience:
 </li>
 <ul>
 <li>
 Ability to learn multiple databases and software systems.
 </li>
 </ul>
 <li>
 Soft Skills:
 </li>
 <ul>
 <li>
 Strong interpersonal and communication skills.
 </li>
 <li>
 Empathy and understanding of diverse cultural perspectives.
 </li>
 <li>
 Ability to work independently and collaboratively within a team.
 </li>
 <li>
 Problem-solving and decision-making abilities.
 </li>
 <li>
 Commitment to upholding ethical standards and confidentiality.
 
 </li>
 </ul>
 </ul>
 
 Additional Preferred Qualifications
 
 
 
 <ul>
 <li>
 HIV experience in a not-for-profit environment.
 
 
 </li>
 </ul>
 
 Statement Of Inclusion
 
 
 
 Vivent Health is an equal opportunity employer and will recruit, hire, promote, and transfer qualified persons into all job classifications regardless of race, gender, religion, skin color, national origin or ancestry, physical disability (including pregnancy), mental disability, age, gender identity, sexual orientation, legally protected medical condition, family care status, marital status, veteran status, genetic characteristics, or any other characteristic protected by federal or state law. Vivent Health complies with other expanded protected classifications that specific county or municipal regulations may mandate.
 
 
 Vivent Health is deeply committed to fostering respect, dignity, and understanding for all individuals affected by HIV, regardless of race, ethnicity, sexual orientation, gender identity, socioeconomic status, or any other characteristic. We are dedicated to cultivating a supportive and inclusive environment that champions advocacy, education, and compassionate care for everyone in our diverse community.
 
 
 Going beyond the law&rsquo;s requirements, Vivent Health places great importance on fostering a culture that celebrates diversity, equity, inclusion, and belonging. We actively seek qualified candidates from different racial, cultural, and economic backgrounds, as we believe that differing perspectives and experiences make us stronger as an organization. Vivent Health encourages all interested persons to apply for this position, and we look forward to learning more about your unique background and qualifications.
 
 
 As a recipient of federal funding, Vivent Health will not hire nor enter a contractual relationship with any party debarred, suspended, or excluded from federal assistance programs.
 
 
 
 Salary
 
 
 
 Starting at $51,000/annually (Depending on Experience)
 
 
 The final salary will be determined based on factors such as market data, internal equity, candidate experience and qualifications.
 
 Please note that it is
 
 
 uncommon for an individual to be hired at or near the top of the range
 
 .
 
 
 
 Public Student Loan Forgiveness
 
 
 
 Employment at our organization may qualify you for federal student loan forgiveness programs. We do not directly pay for &ndash; nor forgive &ndash; federal student loans; however, our status as a not-for-profit organization under Section 501 (c) (3), makes us an eligible employer. There may be other determining factors for one to qualify.
 
 
 Please follow this URL to review one such program and their requirements:
 
 
 https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service
</div>

Case Manager

Peach Tree Healthcare

<div><h3 class="jobSectionHeader">We are seeking a compassionate and experienced Case Manager to provide support and advocacy for individuals with lived experience in homelessness, substance abuse, behavioral health challenges, and justice involvement. The ideal candidate will excel in building meaningful connections with patients, helping them navigate resources, and empowering them to achieve stability and self-sufficiency. This role involves conducting assessments, developing individualized care plans, coordinating services, and working closely with a multidisciplinary team. Strong communication skills, cultural competency, and the ability to foster trust with diverse populations are essential. Experience in trauma-informed care is a plus.</h3>
<h3 class="jobSectionHeader">Qualifications
</h3><h3 class="jobSectionHeader">Must be experienced working with low income, diverse population including persons impacted upon by mental illness or chronic illness. The Case Manager must be experienced with the care and management of chronic health conditions, coordinating care, and behavioral health. This role is responsible for creating and evaluating patient treatment plans, monitoring patient well-being, creating case progress reports, and ensuring patients are well informed regarding their care and treatment options. The Case Manager should have excellent knowledge of case management principles and the ability to act as an advocate for patients in need, providing compassionate highly organized healthcare support.</h3>
<h3 class="jobSectionHeader">Work Experience</h3>

Must have at least one year of experience (3 years preferred) working with behavioral health populations or in a medical clinic setting. Training or experience with Motivational Interviewing,
<h3 class="jobSectionHeader">Education</h3>

Highly Preferred: Associates Degree in mental health or related field.

Preferred: Bachelor&rsquo;s Degree in Social Work, Psychology or related field preferred.
A current CPR certification is required.
<h3 class="jobSectionHeader">
Skills</h3>

Knowledge of treatment care resources as well as available levels of care, ability to relate effectively with behavioral health and medical treatment providers, including PTH patients, family members and other professionals. Excellent PC Skills.

Bilingual Spanish speaking preferred
<h3 class="jobSectionHeader">
Examples of Duties</h3>
<ul><li>The Case Manager will be responsible for the assessment and case management of the PTH program consumers to ensure appropriate level of care and develop a consumer centric plan of care.</li><li>
Willing to be trained and function as a Health Navigator for PTH clients. This includes specific Health Navigation training as well as training in specific Evidenced Based Practices (EBP) as required by the program services.</li><li>
This is a position that will require the candidate to travel regionally to meet with consumers and their families.</li><li>
Drive patients to appointments, public assistance offices, food banks, or other resource organizations as needed.</li><li>
Participates in assessment of consumer needs and develops a consumer centered individual plan of care (IPOC) to address identified needs. Utilizes whole person focus when assessing needs including behavioral, physical, psychosocial, and activities of daily living.</li><li>
Develops, coordinates and assists with implementation and facilitation of services for integrated care program consumers as defined by the individual plan of care.</li><li>
Responsible for facilitating and coordinating with the inter-disciplinary treatment team (ITT) to review the IPOC and ensure access to services and active care team participation.</li><li>
Collaborates with the integrated care program consumer/family, physician and all members of the healthcare team, both internally and externally.</li><li>
Coordinates the delivery of high quality-cost effective care based on the consumers&rsquo; needs and the integrated care services model supported by clinical practice guidelines established by the plan.</li><li>
Advocates for the integrated care program consumer/family among various sites to coordinate resource utilization and evaluation of services.</li><li>
To provide services with a strong recovery orientation, cultural sensitivity, and awareness of the unique needs of the SPMI population.</li><li>
To work within a system of fully electronic record keeping and medical records assuring a comprehensive health history and up to date health and medication information is recorded in the consumer&rsquo;s electronic health record.</li><li>
To attend ongoing training as appropriate.</li><li>
To perform other duties and responsibilities as assigned.</li></ul>
<h3 class="jobSectionHeader">Additional Responsibilities</h3>
<ul><li>Maintains a professional, neat, and well-organized work area.</li><li>
Ability to work with patients and families in multi cultural environment.</li><li>
Provides information in a manner that is ethnically, culturally, and financially sensitive and age appropriate.</li><li>
If multilingual, provides language translation for non-English speaking patients in accordance with demonstrated language.</li><li>
Ability to adapt to change based on the needs of the provider and organization.</li><li>
Organizational skills sufficient to accurately maintain knowledge of current requirements.</li><li>
Stress management sufficient to maintain a professional demeanor while dealing with upset customers.</li></ul>
<h3 class="jobSectionHeader">Travel Requirements</h3>

Occasionally may travel to other sites to attend meetings, training, or to cover other shifts. Driving requirements as outlined in the job duties.
<h3 class="jobSectionHeader">
Tools &amp; Technology</h3>

Tools: Calculators or accessories; Photocopiers; Scanners; Faxing equipment; Computers and Keyboards; Telephones

Technology: Data software - NextGen; Microsoft Office programs; Electronic Mail &ndash; Microsoft Outlook
<h3 class="jobSectionHeader">
Knowledge</h3>

Clerical, Customer and Personal Service, English Language; Medical Terminology, Behavioral Health Terminology
<h3 class="jobSectionHeader">
Abilities</h3>

Oral Comprehension; Oral Expression; Written Comprehension; Written Expression; Problem Sensitivity; Deductive Reasoning; Inductive Reasoning; Near Vision; Speech Clarity; Selective Attention; Speech Recognition; Flexibility in finding solutions to patient issues.
<h3 class="jobSectionHeader">
Work Activities</h3>

Communicating with Supervisors, Peers, or Subordinates; Interacting with Computers; Processing Information; Resolving Conflicts and Negotiating with Others; Updating and Using Relevant Knowledge; Getting Information; Organizing, Planning, and Prioritizing Work; Communicating with Persons Outside Organization; Establishing and Maintaining Interpersonal Relationships; Documenting/Recording Information
<h3 class="jobSectionHeader">
Work Styles</h3>

Integrity; Dependability; Attention to Detail; Social Orientation; Cooperation; Independence; Initiative; Self Control; Adaptability/Flexibility; Concern for Others; Stress Tolerance
<h3 class="jobSectionHeader">
Work Context</h3>

Physical Demands: The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential function of the job, with or without accommodation. Prospective employees must complete a pre-employment medical exam (Occupational Group IV) which will measure the ability to:
<ul><li>
See well enough to read fine print and view a computer screen; speak and hear well enough to understand, respond, and communicate clearly in person and on the telephone; independent body mobility sufficient to stand, sit, walk, lift or move, stoop, and bend to access the work environment and a standard office environment; manual dexterity and sufficient use of hands, arms and shoulders to repetitively operate a keyboard and to write; and the ability to sit or walk for prolonged periods of time.</li><li>
Occasionally may be required to lift/move or assist in lifting/moving up to 50lbs.</li><li>
Reasonable accommodation may be made for some of these physical demands for otherwise qualified individuals who require and request such accommodation.</li></ul>

Work Environment: Generally, a typical office environment.</div>

Celebrating Life Community Health Center

The Lead Care Manager plays a pivotal role in coordinating and managing the care of patients, ensuring they receive comprehensive and effective support services. The ideal candidate will have excellent organizational skills, strong interpersonal abilities, and a commitment to advocating for the well-being of clients.Essential Duties and Responsibilities&middot; Conduct comprehensive assessments of clients' needs, including medical, social, and psychosocial factors.&middot; Develop individualized care plans in collaboration with clients, healthcare providers, and other stakeholders.&middot; Coordinate and facilitate access to healthcare services, including medical appointments, diagnostic tests, and treatments.&middot; Advocate for clients and ensure they receive appropriate healthcare services and resources.&middot; Monitor clients' progress and evaluate the effectiveness of care plans, adjusting as needed.&middot; Provide education and support to clients and their families regarding health conditions, treatment options, and community resources.&middot; Collaborate with interdisciplinary teams, including physicians, nurses, social workers, and community agencies, to coordinate care and services.&middot; Maintain accurate and up-to-date documentation of client interactions, assessments, and care plans.&middot; Identify and address barriers to care, such as transportation issues, financial concerns, and language barriers.&middot; Participate in case conferences, team meetings, and continuing education activities to enhance knowledge and skills.&middot; Serve as the primary point for contact for ECM patients enrolled in the program.&middot; Work with prospective patients to explain the ECM program and provide information.&middot; Outreach to all patients to remain engaged in the ECM program, (e.g. schedule appointments, contact patients with missed appointments, maintain patient logs)&middot; Other duties as assigned.Qualifications, Education, and Training&middot; Bachelor's degree in social work, nursing, psychology, or a related field is preferred.&middot; Previous experience in case management, healthcare, or social services is highly desirable.&middot; Strong communication and interpersonal skills, with the ability to build rapport and establish trust with clients.&middot; Excellent organizational and time management abilities, with the capacity to prioritize tasks and manage multiple cases simultaneously.&middot; Knowledge of community resources and social service agencies, including Medicaid, Medicare, and other public assistance programs.&middot; Ability to work independently and collaboratively as part of a multidisciplinary team.&middot; Compassionate and empathetic attitude towards clients facing challenging circumstances.&middot; Certification in case management (e.g., Certified Case Manager) is a plus but not required.Skills, Knowledge, and Experience&middot; Demonstrated leadership and achievement in a complex healthcare delivery system&middot; Knowledgeable in quality infrastructure, including how to develop and implement decision tools, clinical protocols, guidelines, care management programs, and outcome measurement assessments&middot; Familiarity with electronic medical records&middot; Handles varying situations with tact and diplomacy; ability to mentor/develop direct staff and their teams&middot; A mission-driven individual with a belief in, and commitment to CLCHC&rsquo;s missionExperience working with community-based organizations a plus.Bilingual in Spanish/Russian a plus.Benefits:<ul><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In personPay: $26.00 - $27.50 per hourBenefits:<ul><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

ECM & Community Support Case Manager

Libertana Home Health

JOB DESCRIPTION Position: ECM Case Manager Pay Range: $24.00-$30.00 PER HR Reporting To: CalAIM Program Manager Work Type: Field/remote POSITION SUMMARY: The ECM Case Manager is responsible for the care coordination of ECM Program clients. Care coordination includes identifying, organizing, coordinating, and monitoring services needed by a recipient. The ECM Case Manager assists ECM Program recipients in gaining access to services and other community resources. QUALIFICATIONS: Minimum of two years&rsquo; experience working with homeless and/or low and mixed-income populations, as well as substance abuse, and severe mental health issues. Bachelor&rsquo;s Degree in Health Care or related field preferred. Knowledge of community and housing resources and government benefits/welfare system. The individual in this position must have good verbal and written communication skills as well as the ability to make sound clinical judgments regarding client care. Must be a licensed driver with an automobile that is insured and is in good working order, in accordance with state and/or organizational requirements. Possesses current CPR certification. Current and satisfactory report on pre-employment physical examination including TB Screening Test or chest X-ray as required by Agency policies and procedures. Must be free from signs of infection and illness. ESSENTIAL DUTIES AND RESPONSIBILITIES: The following is a representation of the major duties and responsibilities of this position. The agency will make reasonable accommodations to allow otherwise qualified applicants with disabilities to perform essential functions. Responsible for coordinating with those individuals and/or entities to ensure a seamless experience for the Member and non-duplication of services. Serves as the primary contact to members enrolled in the ECM Program and advocates for members to help them navigate the healthcare while managing their healthcare. Conducts comprehensive risk assessments and care planning in collaboration with the members to develop a Patient-Centered Care Plan. Complete a bio-psycho-social assessment and a Care Plan for each member on their caseload. Oversees the implementation of the client&rsquo;s Care Plan. Develop effective and professional relationships with property owners/managers, housing providers, service providers, care providers, or any relevant providers/partners in the clients continued care. Develop effective, trusting relationships with clients with a focus on facilitating their independence and long-term housing stability. Facilitate linkage to community resources, mental health, substance abuse and medical services and provide transportation when needed. Communicate with mental health, substance abuse and medical providers to ensure continuity of care for the client/member. Connect members to other social services and support the member with other needs they may have, including transportation. Advocate on behalf of Members with health care professionals, including accompaniment to doctor visits. Use motivational interviewing, trauma- informed care, and harm-reduction approaches. Coordinate with hospital staff on discharge plan. Accompany member to office visits, as needed and according to Managed Care Plan (MCP) guidelines. Help clients maintain compliance with treatment plans given to them by medical professionals, this may include medication reminders, service linkages, ordering daily living essentials, and connecting client with DME providers. Monitors service delivery, adhering to the prescribed schedule of client contact. Conducts face to face visit with Members twice a month or as requested/needed. Maintains proper charting, progress notes and case records for each enrolled member in the company EMR system. Track interventions and outcomes. Handles complaints from clients, families or friends. Driving may be required to geographical areas that are covered by the company. Reports all signs of abuse or neglect. Participates in Education, Training and Quality Improvement Activities. Assists the Agency in maintaining compliance with Federal, State, Local and HIPAA Regulations or Joint Commission Standards. Establishes and maintains good relationships with all Health Plans and other vendors. Performs other duties as assigned. PHYSICAL REQUIREMENTS: Stand, sit, talk, hear, and use of hands and fingers to operate computer, telephone, and keyboard on a frequent basis up to 20% of the time. Reach, stoop, kneel and bend up to 15% of the time Moderate amount of walking up to 15% of the time. Moderate amount of driving up to 50%of the time. Close vision requirements due to computer work on a frequent basis Light to moderate lifting may be required up to 25lbs on a frequent basis. Pushing and pulling up to 25lbs.

ECM Case Manager

NMC Health plc

<div>The Case Manager is responsible for coordinating patient care, managing insurance approvals, monitoring resource utilization, and ensuring efficient discharge planning while supporting the Revenue Cycle Department. The role focuses on optimizing insurance approvals, reducing claim denials, ensuring medical necessity documentation, and improving hospital revenue through effective case and utilization management in compliance with UAE healthcare regulations.</div>
 <div><div><ul><li>Case Management &amp; Care Coordination
</li></ul></div><ul><li>Assess patient medical and clinical needs
</li><li>Coordinate with physicians and nursing teams for treatment planning
</li><li>Monitor patient progress and length of stay
</li><li>Identify high-risk and long-stay patients
</li><li>Facilitate patient transfers in collaboration with clinical teams, ensuring medical records, treatment plans, and discharge documentation are complete. 
</li></ul>2. Insurance &amp; Revenue Cycle Coordination
<ul><li>Coordinate with insurance companies and TPAs for approvals through the RCM Approval unit
</li><li>Ensure timely pre-authorizations and concurrent approvals
</li><li>Monitor insurance coverage and eligibility
</li><li>Support denial prevention and claim accuracy
</li><li>Work closely with billing and coding teams
</li><li>Ensure proper clinical documentation for claims submission
</li><li>Facilitate insurance company and TPA visits for medical file reviews and case audits.
</li><li>Monitor and ensure timely bill updates by coordinating with clinical, coding, and billing teams to avoid claim delays and ensure accurate revenue capture. 
</li></ul><div><ul><li>Real-Time Visibility &amp; Escalation of Inpatient Pending Approvals
</li></ul></div>Maintaining real time tracking of all Inpatient pending approvals and escalate cases exceeding defined turnaround times to relevant stakeholders (Clinical team, RCM insurance). 
<ul><li>
</li></ul>4. Utilization Management
<ul><li>Monitor Average Length of Stay (ALOS)
</li><li>Ensure efficient use of hospital resources
</li><li>Conduct concurrent and retrospective case reviews
</li><li>Support cost-effective treatment planning
</li>Ensure compliance with payer guidelines 
<li>
</li></ul>5. Discharge Planning
<ul><li>Coordinate safe and timely discharge
</li><li>Ensure discharge documentation is complete
</li>Coordinate follow-up care and insurance approvals 
<li>
</li></ul>6. Documentation &amp; Compliance
<ul><li>Coordinate with the clinical team to ensure proper and complete medical documentation to support insurance approvals, coding, and billing requirements.
</li><li>Maintain accurate case management records
</li><li>Ensure compliance with health regulations, Insurance policies, and hospital revenue cycle policies
</li><li>Support Insurance audits
</li><li>Prepare utilization and case management reports 
</li></ul>7. Revenue &amp; Quality Support
<ul><li>Reduce insurance rejection rate
</li><li>Improve approval turnaround time
</li><li>Support revenue optimization
</li><li>Monitor case management KPIs
<ul><li>Insurance Inpatient approval turnaround time
<ul><li>Reduce Rejection Rate
</li><li>Average Length of Stay (ALOS)
</li><li>Claim documentation accuracy
</li><li>Discharge efficiency
</li><li>Revenue cycle support performance
</li><li>Utilization review compliance
</li><li>Patient throughput
</li></ul></li></ul></li><li>Participate in revenue cycle and clinical meetings</li></ul></div>
 <div>Education
<div><ul><li>MBBS / MD / BSN
</li></ul><ul><li>Certified Professional Coder
</li></ul></div>Experience
<ul><li>Minimum 3 years UAE Hospital experience
</li><li>Experience in case management, utilization review, discharge planning preferred
</li></ul>Experience working with insurance and TPAs is an advantage</div>

The W Group

<div>
 Lead Case Manager &ndash; Sanford Manor
 
 
 Schedule: Monday through Friday 9am-5pm
 
 
 Excellent Benefits
 
 
 <ul>
 <li>
 Supportive Management
 </li>
 <li>
 Immediately Available
 
 
 
 </li>
 </ul>
 
 Sanford Manor
 
 , part of
 
 The W Assisted Living Management Company
 
 , is seeking a compassionate, organized, and motivated
 
 Lead Case Manager
 
 to join our team. This is a hands-on leadership role responsible for coordinating resident services and supporting a small case management team, with a strong focus on resident satisfaction, smooth admissions/discharges, and clear documentation.
 
 
 What You&rsquo;ll Do
 
 
 <ul>
 <li>
 Lead and support a team of 2 Case Managers (workflow oversight, guidance, and daily coordination)
 </li>
 <li>
 Maintain firm adherence to each resident&rsquo;s Bill of Rights and advocate for resident-centered care
 </li>
 <li>
 Maintain meaningful communication with residents, families, care providers, and community partners to ensure continuity of care
 </li>
 <li>
 Coordinate admissions/re-admissions from the community, hospitals, nursing homes, and other settings
 </li>
 <li>
 Support resident assessments and service planning to meet resident needs and facility requirements
 </li>
 <li>
 Collaborate with a multidisciplinary team (administration, nursing, social services, and outside providers)
 </li>
 <li>
 Ensure clear, timely, and accurate documentation in accordance with facility policies and regulations
 </li>
 <li>
 Identify barriers to care, escalate concerns appropriately, and help drive solutions that improve outcomes and satisfaction
 
 
 
 </li>
 </ul>
 
 Qualifications / Requirements
 
 
 
 <ul>
 <li>
 Associate&rsquo;s Degree in Healthcare (required)
 </li>
 <li>
 2+ years of case management experience (assisted living/long-term care preferred)
 </li>
 <li>
 Prior experience in assisted living/adult care/long-term care strongly preferred
 </li>
 <li>
 Strong phone, communication, and follow-up skills with families and care providers
 </li>
 <li>
 Excellent organization, documentation, and time-management skills
 </li>
 <li>
 Ability to lead by example and work cooperatively with a multidisciplinary team
 </li>
 <li>
 Bachelor&rsquo;s degree preferred but not required
 
 
 
 </li>
 </ul>
 
 Benefits
 
 
 
 <ul>
 <li>
 Competitive pay
 </li>
 <li>
 Health benefits offered
 </li>
 <li>
 Paid time off
 </li>
 <li>
 Paid sick time
 </li>
 <li>
 Paid holidays
 </li>
 <li>
 Unlimited employee referral bonuses
 </li>
 <li>
 Growth and development paths specific to your interests
 </li>
 <li>
 Supportive management (open-door policy)
 </li>
 <li>
 Reliable schedule
 
 
 
 </li>
 </ul>
 Why Work at The W Group?
 
 
 The W Group is proud to be one of the largest providers of senior living and adult care in New York State. We&rsquo;re a values-based organization with a culture rooted in collaboration, encouragement, and camaraderie. In this role, you&rsquo;ll have the opportunity to innovate, make an impact, and grow with a company that invests in its people.
</div>

Lead Case Manager

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