The Supervisor Case Management at BlueCross BlueShield of Tennessee is responsible for monitoring productivity and performance based on departmental goals, identifying areas for quality improvement, ensuring updated processes are implemented, supervising staff, coordinating clinical interfaces, and facilitating the implementation of clinical management programs. This role requires a Registered Nurse with an active license in Tennessee or a license in their state of residence if participating in the Nurse Licensure Compact Law, and experience in healthcare, clinical, and leadership roles.

Supervisor Case Management - Middle Grand Region, TN - Select Community

Supervisor Case Management

The 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. The position is remote and requires the candidate to reside in the CST time zone.

Care Manager (RN)

Molina Healthcare is seeking a Registered Nurse with experience in Hospital Acute Care, Concurrent Review/Utilization Review, and knowledge of Interqual/MCG guidelines for an Inpatient Review Case Manager role. The position requires California licensure and involves working from home with a high degree of scheduling flexibility, including the ability to work weekends and holidays. The role focuses on assessing inpatient services for members to ensure optimum outcomes, cost-effectiveness, and compliance with all state and federal regulations and guidelines.

Inpatient Review (RN) Case Manager, California Pacific Hours

Inpatient Review Case Manager

The Telephonic Nurse Case Manager I is responsible for telephonic care management within the scope of licensure for members with complex and chronic care needs. This role involves assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care across the care continuum. The position is virtual, requiring residency in the State of Georgia and multistate licensure.

Telephonic Nurse Case Manager I

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

The Clinical Case Manager Behavioral Health at CVS Health is responsible for utilizing advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services. This role aims to promote effective utilization of available resources and optimal, cost-effective outcomes. The position is fully remote in the USA, with standard business hours Monday to Friday, no weekends or holidays.

Clinical Case Manager Behavioral Health DSNP-Spanish Speaking

Clinical Case Manager Behavioral Health

As an experienced M.D. or D.O. in a managed care or healthcare administration setting, you will partner closely with the internal Case Management and Health Services Quality teams to coordinate care through evidence-based decision making. You will also lead the Quality Improvement Committee and chair the Credentialing Committee, perform outpatient case reviews, and support NCQA accreditation and quality case reviews. This role requires decisiveness, strong analytical and critical thinking skills, and the ability to influence internally and externally.

Medical Director Case Management & Quality

The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs. This role involves assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care across the care continuum. The position is virtual, requiring candidates to reside within 50 miles of an Elevance Health Pulse Point location and will service members in different states, necessitating Multi-State Licensure.

Telephonic Nurse Case Manager II

The Clinical Program Manager at WPS Health Solutions is responsible for improving the operational and financial health of the clinical organization. This role involves identifying best practices, cost-saving opportunities, and assisting with network and benefit design. The manager will work closely with clinical leadership, product, and sales teams to develop and implement programs, ensuring timely completion of key deliverables. The position requires strong communication skills, the ability to secure stakeholder buy-in, and a focus on driving efficiencies and optimizing clinical processes.

Clinical Program Management - Remote

Clinical Program Manager

The HUB Case Manager at Orsini Specialty Pharmacy assists with the requirements of manufacturer's patient support programs, focusing on education, patient outreach, financial support, adherence calls, and other communication support to ensure high customer service and satisfaction. This role requires a high level of customer service skills, urgency, and accountability, and may involve additional responsibilities based on manufacturer requirements.

HUB Case Manager - Remote

HUB Case Manager

The Care Manager at Centene Corporation is responsible for developing, assessing, and facilitating complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes. This includes personalized care plans and education for members and their families related to mental health and substance use disorder. The role involves evaluating member needs, recommending and facilitating care plans, coordinating between members, families/caregivers, community resources, and care providers, and ensuring compliance with regulators.

Care Manager

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

The Case Management Specialist at CVS Health is a member of the Care Team responsible for the care management of members enrolled in the Dual Special Needs Plan with limited health conditions. This role involves assessing member needs, gaps in care, communicating with the member's Primary Care Provider, maintaining updated individualized care plans, and participating in Interdisciplinary team meetings. The position is full-time, remote, and requires living in the Eastern Standard Time zone.

Analyst, Case Management Specialist - Must live in EST

Case Management Specialist

Molina Healthcare Services works with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. This role supports the Complex Adult Case Management program, requiring a Registered Nurse with previous Case/Care Management and managed care experience, particularly in managing complex/chronic medical conditions and knowledge of community resources for social determinants of health concerns. The position is remote, requiring residence in New York and familiarity with upstate and downstate regions.

Registered Nurse Case Manager Complex Care Remote in New York

Registered Nurse Case Manager Complex Care

The Clinical Case Manager BH at CVS Health is a full-time telework role based in Maricopa County, Arizona, requiring up to 50% travel within an assigned region. This role involves utilizing clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. The position focuses on applying critical thinking, knowledge in clinically appropriate treatment, and evidence-based care to provide care coordination, support, and education for members through the use of care management tools and resources.

Clinical Case Manager BH

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