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The body is often curable, the soul is ever so....this statement embodies the mission of Lourdes Health System.

The body is often curable, the soul is ever so....this statement embodies the mission of Lourdes Health System. Lourdes´ is rich in the tradition of the Franciscan tradition of service to the community, and adopted a holistic healthcare model of care in 1958 - . You can have it all at Lourdes - feel our healing strength.Position Summary: The Care Manager is the leadership associate responsible for assisting with the planning, organizing, coordinating, implementing and evaluating the administrative operations and clinical practice activities within one or more areas on a twenty-four hour basis. A priority of this position is for the Care Manager to assist the Chief Retention Officer to achieve goals on staff development, staff satisfaction and staff retention. Provides patient reviews that are coordinated to provide a seamless, integrated system of care that is high value, cost effective and customer focused. The Care Manager is committed to creating a work environment that fosters pride, teamwork and continuous learning and associate ability to meet patient needs. The Care Manager must have knowledge of specialty services and related nursing standards and be aware of the changing health care environment locally and nationwide. The Care Manager must possess outstanding verbal and written communication skills and have an understanding and acceptance of Franciscan Philosophy and Standards of Service Excellence.Qualifications:- Minimum AS degree required; BS degree preferred. Minimum 2-4 years exp required, 5-8 years exp preferred Required license or certifications:1. RN license 2. PR 3. Membership in professional organizationPreferred license or certifications are:1. Bachelor´s Degree (if not possessed upon hire, a plan for completion will be a component of the appointment process)2. CNN certification Specialized Skills:The minimum specific knowledge and skills necessary to perform this job:1. Ability to organize, prioritize, and manage multiple projects: lead, mentor, and persuade others as needed to accomplish projects.2. Ability to think critically, develop conceptual designs for clinical services and plan and organize successful projects.3. Proficient knowledge of PC applications 4. Highly effective verbal and written communication skills Preferred knowledge and skills necessary to perform this job:1. Demonstrates the ability to function autonomously and is an independent decision maker2. Demonstrates effectiveness as a group leader and participant and the ability to collaborate with multiple members of the health care and administrative leadership team3. Ability to demonstrate knowledge and skills necessary to manage care appropriate to the age of the patient served within areas of responsibility4. Incorporates knowledge of the principles of growth and development into service design and processes the ability to assess data reflective of the patients age specific needs 5. Certified in area of practice/administrationConveniently located approximately 7-10 miles east of Philadelphia, 80 miles north of Washington DC and 90 miles south of New York CityDiversity lights our way EOE/M/F/D/V

Our Columbus Ohio office is actively seeking RNs with strong disease management experience!! Our Health Coaches provide telephonic outreach to disease management plan members. In this position, the Health Coach will conduct assessments and develop treatment plans and interventions; help the client set both short and long term goals; and monitor progress towards goal attainment. The coach will provide positive reinforcement, advice, and support. The position is 32 hours per week and eligible for benefits. Hours vary from 8am-8pm. ESSENTIAL FUNCTIONSActivities include assessment, problem identification, goal setting, and implementation of interventions Communicate with member regarding needs and develop mutually agreeable care plansEducate the participants about their disease state as well as other health issues relating to their plan of care Collect clinical data and enter in the APS customized system for tracking and metrics reporting purposes Monitoring for quality of care and outcome improvement in accordance with clinical indicatorsEDUCATION REQUIREMENTSGraduation from accredited nursing program. BSN preferred.Current unrestricted Ohio RN license required.EXPERIENCEMinimum of 3 years experience in chronic/disease care management and/or primary care case managementStrong background in disease management. Experience managing members with chronic illness, behavior modification, goal setting and evaluationSKILLS Exceptional verbal and written communication skills Ability to multitask in a call center environment is required. Above average computer/technical skills Exceptional communication skills with a customer service focus

Our NW Las Vegas office is actively seeking RN´s with strong case management experience!!

Tired of working nights and weekends? Would you like the opportunity to empower people w/ health knowledge so they become active partners in their care? Then consider exploring an opportunity at APS Healthcare, a health services organization dedicated to making a significant, positive impact on the healthcare system by changing behaviors and improving clinical and financial outcomes.The RN Health Coach is responsible for primary contact and liaison activities with one of our commercial clients. This program engages in a collaborative approach with providers to ensure members are accessing services in an appropriate and timely manner. Communicating with providers in the community regarding the members treatment needs and developing appropriate care plans for specialized needs of members Monitoring for quality of care and outcome improvement in accordance with clinical indicators as per contractual obligations Providing telephonic interventions with high risk beneficiaries Telephonic only Interacting with beneficiaries in other risk groups as needed Providing telephonic chronic care management, training, medical record reviews and other clinically based activities as assigned, based upon recipients severity of condition Activities include assessment, planning, implementing, coordinating, monitoring and evaluating the services and resources necessary to respond to an individual members health needs Educating the participants about their disease state as well as other health issues relating to their plan of care Collecting clinical data and entering the APS C3 for tracking and metrics reporting purposesEDUCATION REQUIREMENTS:Graduation from accredited nursing program. BSN preferred.Current unrestricted Nevada RN license required.EXPERIENCE:Minimum of 3 years experience in related public sector medical services including experience with quality improvement, medical record reviews, chronic/disease care management and/or primary care case managementStrong background in case management and discharge planning. CCM preferred. Experience managing members with chronic illness, behavior modification, goal setting, and providing constructive feedback preferred Strong verbal and written communication skills, prior experience in a training or educational capacity strongly desired Previous experience in delivering care management servicesAbove average computer/technical skills Exceptional communication skills with a customer service focus Ability to resolve problems in a non-threatening manner

Yoh has a direct hire opportunity for a Coordinated Care Center Case Manager to join our client in Rancho Cucamonga, CA.Job Overview: Registered Nurse or Licensed Vocational Nurse that is experienced as a Coordinated Care Center Case Manager Job Responsibilities: Candidate will be responsible for coordinating member care for a Care center located in Rancho Cucamonga, CA Job Qualifications: Licensed Registered Nurse or Licensed Vocational Nurse in state of CA Bachelor of Science Degree in Nursing is preferred but will accept an Associates Degree also Certification in Case Management is preferredAt least 3 yrs of Experience in Case Management or Disease Management in a Managed Care settingAble to coordinate comprehensive health care services in a cost and quality effective manner for senior members Able to support assessment of needs, coordination of home appointments- Candidate must have strong interpersonal skillsDiscover all thats possible with Yoh. Apply now.

Discover all that’s possible with Yoh Health Care. Apply now.

Yoh Health Care has a direct hire opportunity for a Director of Quality and Case Management to join our client in Irving, TX. Our client is the largest private operator of health care facilities in the United States, operating facilities worldwide.Description: The Director of Quality and Case Management is responsible for: - Providing overall leadership and strategic planning for the Quality and Case Management departments- Providing and/or overseeing department / program evaluation, development of goals, creation and implementation of action plans- Communicating the direction, vision and values of the Organization- Directs multiple facility wide functions including performance improvement, patient safety, risk management, regulatory compliance and infection control- Also handles the consultation and education for management and hospital staff regarding the above aspects of Quality and Risk Management. Supervise: Supervisor and staff of Quality and Case Management Departments.Job Responsibilities: - Prepares and monitors departmental budgets- Oversees/provides for staffing plans / schedules; compliance with productivity targets- Provide for timely staff evaluations- In conjunction with organizational strategic plans, identifies opportunities for departmental improvements and implements appropriate action plans to optimize department outcomes.- Provides departmental needs assessment; identifies goals, develops and implements action plans in order to achieve objectives- Develops and implements programs / activities to optimize patient length of stay, assures timely patient through-put and ensures appropriate discharge planning- Oversees provision of direct clinical social services to areas of the Hospital served- Facilitates problem solving with other departments as indicated- Maintains current knowledge of governmental regulations, contractual issues and third party payor requirements - assures departmental compliance of same- As indicated, provides staff, physician and community education related to above regulations / requirements- Develops, revises and maintains departmental policies and procedures as indicated- Promotes and maintains positive relations with continuum of care providers- Provides outcomes reports as requested / required for Hospital and Medical Staff committees- Performs other duties as assignedJob Qualifications: - Bachelor´s degree; Master´s degree preferred- Current Texas RN license- Minimum of 2 years experience at a director level is required- Five (5) years experience of Quality, Utilization/Case Management and discharge planning in an acute care hospital- Knowledge of / experience with performance improvement activity- Knowledge of state and federal regulations- Knowledge of Joint Commission standards- Computer skills (minimally Word and basic Excel)- Strong /effective verbal and written communication skillsPreferred:- Minimum of 5 years of director level management experience in an acute hospital case management department (UR/DP).- Strong interpersonal skills that reflect a positive attitude and sense of commitment to patients, the hospital, the departments and the community.

Our mission -- a passion for excellence, compassion for you -- drives everything we do at Reston Hospital Center. It was the heart of our journey to Magnet Recognition, and is in the hearts of our nurses, physicians and staff each day as they care for patients in our hospital.Clinical Case Manager - Case Management - 1.0 FTE(Job Number: 08540-2995) Virginia-Northern Virginia-Reston Hospital Center - RestonSchedule: Full-time Description Job Functions 1. Performs admission and continued stay reviews as outlined in UR plan.2. Perform reviews using approved criteria to evaluate necessity of admissions and continued stays.3. Consults with attending physicians, nursing staff, and discharge planning assistant to ensure timely discharge of patients of patients to home or other level of care.4. Performs a monthly analysis of UR activities.5. Reports results of UR activities to appropriate persons and committees.6. Maintains accurate records of all UR reviews and activities.7. Assists in the collection of data for quality improvement purposes.8. Complies with JCAHO standards for UR.9. Is thoroughly familiar with all aspects of UR plan.10. Participates in review and revision of UR plan.11. Stays abreast of latest trends and developments in case management.12. Provides initial and ongoing patient assessment with emphasis on the total needs at discharge.13. Initiates referrals to appropriate community agencies and services and provides information to patient about hospital community resources.14. Assists patients and family with locating nursing home beds, rehabilitative care and home care.15. Works with nursing and other clinical departments to establish and coordinate discharge plan.16. Assists or performs the duties of the discharge planning assistant. Qualifications QUALIFICATIONS Education: Graduate of an accredited school of nursing or accredited school of social work. Licensure: Current licensure as a Registered Nurse in the Commonwealth of Virginia, if applicable. Experience: Previous clinical experience in a hospital setting is strongly preferred. Experience in utilization management and discharge planning required. Previous experience with computerized systems preferred.

Are you looking to make a difference in the lives of women and children?

HealthCare USA of Missouri, is a dynamic health maintenance organization located in St. Louis, MO with the following Full-Time opportunity available: Medical Review NurseHealthCare USA is seeking an individual that will be responsible for reviewing and analyzing information to make medical determinations as necessary. Applies clinical knowledge to assess the medical necessity, level of services, and/or appropriateness of care in cases requiring prospective, concurrent, or retrospective utilization review.ESSENTIAL RESPONSIBILITIESBased on area of specialization, employee may perform any or all of the responsibilities listed below.Claims Review-- Conducts medical reviews of individual provider and hospital claims for coding and billing accuracy and medical appropriateness for all products in support of company medical payment policies and cost containment initiatives.-- Processes and/or reviews claims for compliance and level of care in a timely manner that meets or exceeds production and quality goals. Reviews all complex physician, facility, and specialty claims and adjustments to ensure compliance with company policies and procedures.-- Assesses, investigates and resolves information to respond to difficult inquiries including, but not limited to, authorizations, payments, denials and coordination of benefits.-- Interfaces with customers by telephone, correspondence and/or in person to answer questions and resolve process issues.Utilization Management-- Conducts retrospective medical necessity and experimental/investigational reviews of inpatient admissions, diagnostic testing and ambulatory services. Meets health plan or applicable accreditation organizational requirements for decision-making and notification process timeframes.-- Utilizes established criteria to authorize inpatient admissions, diagnostic testing and ambulatory services. Makes referrals to the health plan/clinical operations Medical Director for determinations when criteria are not met.-- Communicates determinations verbally and/or in writing to appropriate business department as required by the health plan/business department internal workflow policies.Pre-Existing Condition Review-- Coordinates, directs, and performs retrospective reviews of individual medical history to identify possible pre-existing conditions.-- Conducts analysis and research of medical and claims history to make payment determination.-- Actively identifies possible fraud/misrepresentation cases. May assist with preparation of cases for referral to medical underwriting and medical management.All Functions-- Identifies training needs within the team. May train service teams based on outcomes of medical reviews as well as process and/or procedure changes.-- Drives the team to identify and implement process improvements; encourages ownership of and group participation in improvement initiatives.-- Identifies and recommends opportunities for cost savings and improving outcomes.-- Performs other duties as required.JOB SPECIFICATIONS-- Registered Nurse with a current RN license in good standing in the state where job duties are performed.-- Bachelors degree and/or Certified Professional Code-CPC-H preferred.-- Previous (3-5 years) clinical experience.-- Knowledge of medical terminology and ICD-9, CPT-4, and HCPCS coding.-- Working knowledge of coordination of benefits and health care products under both fully insured and self-funded arrangements preferred.-- Strong analytical and problem solving skills.-- Excellent organizational, interpersonal and communication skills.HealthCare USA is an Equal Employment Opportunity/Affirmative Action employer.

Our team is made up of 15,000 individuals united by one purpose: to make the most of each other’s talents. That means you’ll have the support and the resources you need to pursue your goals. Join us here for a rewarding future that focuses on what matters most to you.HCA Hospital Corporation of AmericaJoin us at Blake Medical Center, part of the growing HCA West Florida hospital system. Here, you´re sure to enjoy our 13-acre tropical campus, just blocks from the beautiful Gulf of Mexico. Our 383-bed acute care facility is technologically advanced and proficient in over 30 specialties, such as:       * ´Top 100´ ICU     * Cardiovascular ICU     * Emergency Services     * Progressive Care/Telemetry     * Rehabilitation Center     * Surgical Services As an integral part of the nation´s largest healthcare system, HCA West Florida hospitals give employees more support than you can possibly imagine. Each of our 13 hospitals is fully equipped with the latest technology and the greatest resources, so you can provide the highest quality care possible. In return for your dedication, we offer a generous benefits package, tuition reimbursement and professional learning opportunities. Plus a lot of extra incentives that make life much more rewarding. To learn more about Blake Medical Center please visit: www.MoreCareerChoices.com Required Job Qualifications include: Current licensure as an RNGraduate of an accredited school of professional nursing.  Bachelor´s of Science in Nursing preferred.CCM preferred Minimum 5 years of clinical nursing experience.Knowledge of CMS guidelines and experience working with payor specific guidelines and contractual rules preferred.Customer service abilities including effective listening skills.Critical thinking skills, decisive judgment and the ability to work with minimal supervision meeting firm deadlines.Assertive and persuasive communication skills, action oriented.

Specializing in you...serving San Diego´s inland North County communities for more than 50 years, Palomar Pomerado Health is a family of outstanding healthcare facilities that cover an area of more than 800-square miles.

Managed Care RAC AnalystPalomar Pomerado HealthFull TimeSpecializing in you...serving San Diego´s inland North County communities for more than 50 years, Palomar Pomerado Health is a family of outstanding healthcare facilities that cover an area of more than 800-square miles. We are the largest hospital district in Southern California and the first California designated health system to receive ANCC Magnet® Recognition. From our state-of-the-art Cardiac Care and Rehabilitation Facilities and busy Trauma Center to Home Healthcare, we deliver a full spectrum of health services to meet the needs of every member in our community. We have an excellent opportunity for a Managed Care RAC Analyst. A Recovery Audit Contractor (RAC) Analyst requires a diverse set of organizational skills, medical chart review and analysis, knowledge of claims appeal process and ability to apply (Interqual, Milliman) practice management guidelines to determine medical necessity. Responsibilities include:• Research complex issues pertaining to Medicare & Medi-Cal reimbursement/payment polices. • Ability to synthesize the information, concisely communicate either verbally or in writing findings and recommendations. • Responsible to present and/or defend audit findings to appropriate internal and external stakeholders (i.e. hospitals, physicians, attorneys, judges, etc). • Creatively and effectively solve problems, develop and implement policy and procedures, perform analysis and prepare reports. • Provides backup support for PFS Denials RN as needed. • Trains/mentors Denials RN on all facets of RAC program for coverage as needed. • Performs other duties as assigned. • Follows PPH rules, policies, procedures, applicable laws, and standards. • Carries out the mission, vision, values, and quality commitment of PPH.We promote a philosophy that encourages growth and satisfaction. We provide a work environment that is open and empowering, where you can experience a wide range of clinical, educational, and management opportunities. We also support a healthy balance between your personal and professional lives. We are located in an area that is enriched with a sense of belonging, where everyone pulls together in a common philosophy of life. It´s an area that affords all who live here the luxury to pursue any interest or lifestyle they choose.RequirementsMinimum Education: As required by certification and/or licensurePreferred Education: Bachelor´s Degree in nursing, healthcare, business administration, accounting or related fieldMinimum Experience:- 2 years case management, utilization review, or denials management. Independent thinker, logical, strategic, with an attention to detail.- Effective communication style (written and verbal) with proven ability to positively influence behavior and outcomes.Preferred Experience: Clinical Documentation Integrity (CDI) and legal experience with demonstrated success researching local, state and federal laws and regulationsRequired License: Current CA RN License and Valid Driver´s LicenseWe invite you to join us in our Mission to Heal, Comfort, and Promote Health in the Communities We Serve!

RN Supervisor - Regional Case ManagementLocationThis position is located in Kearny Mesa. Occasional travel between Sharp HealthCare facilities, and SNF; must provide own transportation.Hours8-hour shift; 8:00 am 5:00 pm, weekends as needed.Qualifications*Current California Registered Nurse license required. *Utilization, Case Management, or Quality Management certification preferred.*Bachelor´s degree in health care preferred. Education as required for licensure, if licensed.*Minimum three years experience in a variety of acute patient care settings required.*Minimum three years Medical Management experience, preferably in managed care, with supervisory experience required.*Strong organizational skills with ability to work well under pressure with conflicting priorities. *Ability to read, speak and hear English clearly.*Occasional travel between Sharp HealthCare facilities and provider offices; must provide own transportation.SummaryManage an effective in-patient Care Management program that includes initial and concurrent review; case management/discharge planning activities. Responsible for operational planning consistent with existing policies and/or principles. Responsible for managing medical management activities to include tracking, trending and analyzing UM data.