Software Guidance & Assistance, Inc. is seeking a Managed Care Analyst for a contract assignment with a healthcare client in Los Angeles, CA. This role involves troubleshooting, maintenance, and optimization of existing software applications, as well as designing, building, testing, and supporting new applications within a portfolio or service line. The analyst will work closely with business owners, vendors, and other team members to evaluate and recommend solutions to complex problems, ensuring in-depth knowledge of the software application and operational workflows.

Tapestry Managed Care Analyst

Managed Care Analyst

The Medical Management Team Lead, RN at McLaren Health Care is responsible for providing clinical oversight of staff and functions to meet organizational goals in utilization, disease, case, and medical management. This role involves expert knowledge of screening criteria, clinical criteria, and research abilities, independent judgment within the scope of practice, and participation in the medical management of members across all product lines. The position emphasizes member advocacy through education on managed care, disease management, and PCP treatment plans, while also monitoring utilization patterns and collaborating on complex cases.

Medical Management Team Lead, RN, MI - Remote - McLaren Careers

Medical Management Team Lead, RN

The Clinical Care Team Manager at Guidehealth is responsible for the day-to-day operations of an integrated multi-disciplinary clinical and clinical support structure to effectively monitor, support, and lead Value Based clinical initiatives. This includes case management, transitions of care, care coordination and continuity, provider/staff education on ACO/MA Plan clinical programs, and building and maintaining a network of community support. The role requires strong leadership, management, and interpersonal skills, as well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the organization.

Remote Clinical Care Team Manager

Clinical Care Team Manager

We are seeking a dedicated Chronic Care Manager to provide one-on-one attention via telephone calls to patients with two or more chronic diagnoses. The Chronic Care Manager will collect patient health information to identify risks, provide education, and encourage compliance with treatment. This role involves creating patient-specific Care Plans that outline goals and interventions to implement, monitor, and support the patient's needs as defined by the Primary Care Physician (PCP). The Chronic Care Management (CCM) program aims to support patients and promote the highest level of quality care.

Chronic Care Management

Chronic Care Manager (LPN)

The Care Manager/Coordinator (RN/SW) at AmeriHealth Caritas is responsible for engaging members, their caregivers, and providers to assess, plan, and establish individual member goals for achieving optimal health through self-management. This role involves facilitating and coordinating care, ensuring quality and cost-effective resource use, and acting as a single point of contact and advocate for members in the care coordination program. The position also includes overseeing care management activities within assigned practices to ensure high-quality services in line with Plan, NCQA, Federal/State standards.

Care Manager II - Remote Philadelphia area only

Care Manager II

The Pediatric Care Manager, RN at Centene Corporation is responsible for developing, assessing, and facilitating complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes. This includes personalized care plans and education for members and their families. The role involves evaluating member needs, developing care plans, coordinating care, and providing education and support. This is a remote position with local travel required for member visits, and candidates must reside in Broward County, Florida, with a preference for those in Pembroke Pines, Weston, or Dania Beach.

Pediatric Care Manager, RN (ECC)

Pediatric Care Manager, RN

Molina Healthcare is seeking a Case Manager RN to support members recently admitted to the hospital, ensuring a successful transition from inpatient to outpatient care. This role involves working remotely to coordinate care, conduct face-to-face and home visits, and educate members on various aspects of care. The position requires excellent computer skills, attention to detail, and the ability to multitask. Previous experience in case management, managed care, hospital, and/or home health is preferred.

Case Manager RN - Transition of Care Coach

Lap of Love is seeking a Patient Care Manager to support its Practice Operations department. This role involves overseeing active hospice patients and aftercare services, ensuring consistent quality care for families and veterinary associates. The Patient Care Manager will leverage their veterinary practice management skills to elevate end-of-life care services and lead the hospice care team using a servant leadership style.

Patient Care Manager

The RN Care Manager at HCA Healthcare is a remote position focused on enhancing the patient and primary care relationship through care delivery. This role involves serving as a subject matter expert in quality and value-based care programs, developing professional relationships with healthcare providers and staff, and assisting in education and workflow processes to meet organizational goals. The position requires a current RN licensure and offers a comprehensive benefits package.

RN Care Manager WFH-Local

RN Care Manager

The Care Manager Transition of Care at Centene Corporation performs care management duties to assess, plan, and coordinate aspects of medical and supporting services across the continuum of care for post-discharge members, promoting quality and cost-effective care. This role involves completing medication review for pre-admission and post-discharge reconciliation, working with care management and coordination teams to identify transition support services, and facilitating the transition into active care management based on member needs.

Care Manager Transition of Care (CA Only)

Care Manager Transition of Care

As a Care Manager RN at CVS Health, you will be a frontline advocate for members who cannot advocate for themselves, responsible for assessing, planning, implementing, and coordinating all case management activities to evaluate the medical needs of the member to facilitate the member's overall wellness. This role involves developing a proactive plan of care, using clinical tools to conduct evaluations, applying clinical judgment, and collaborating with various stakeholders to address the full continuum of a member's health care and social determinant needs.

Care Manager RN

The Care Manager RN at HCA Healthcare supports the patient and primary care relationship through care delivery enhancement, including telephonic outreach, care management, preventive services, and self-management. This role is integral to the Division Care Coordination team, assisting primary care providers and practices in meeting quality improvement initiatives. The position requires working from home but must be based in the San Antonio, Texas area or willing to relocate.

Care Manager RN WFH

The Care Manager at CareFirst is responsible for researching and analyzing members' medical and behavioral health needs and healthcare cost drivers. They work closely with members and the interdisciplinary care team to ensure an effective plan of care and positive member experience, leading to optimal health and cost-effective outcomes. This role involves identifying members with acute/complex conditions, engaging with them and their providers to develop comprehensive care plans, and facilitating program and community referrals.

Care Manager (MD-DC-Northern VA) (Remote)

Care Manager

The Care Manager at Magellan Health Services is responsible for authorizing and reviewing utilization of mental health and substance abuse services in both inpatient and outpatient care settings. This role involves collecting and analyzing utilization data, assisting with discharge planning and care coordination, providing member assistance with mental health and substance abuse issues, and participating in special quality improvement projects. The position requires collaboration with other clinical team members, interaction with Physician Advisors, and participation in network development activities.

Care Manager (UM/UR) - Remote, Idaho Licensed

The RN Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs. This includes assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care across the care continuum. The role is remote for the Central region, requiring residency within 50 miles of the Richmond office in Virginia.

RN Nurse Case Mgr I

RN Nurse Case Manager I

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