![Optum](https://media.trabajo.org/img/noimg.jpg)
Patient Case Manager
4 weeks ago
Independently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in department huddles Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better on a monthly basis Adheres to organizational and departmental policies and procedures Maintain current licensure to work in State of employment and maintain hospital credentialing as indicated Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms Refers cases to UM Medical Director as appropriate for review for cases not meeting medical necessity criteria or for complex case situations
Monitors for any quality concerns regarding member care and reports as per policy and procedure This is an office/hybrid position near Padre Island Rd
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Bachelor’s degree in Nursing and/or Associate’s degree in Nursing combined with 4+ years of experience
2+ years of managed care and/or case management experience Proven knowledge in Microsoft Office applications including Outlook, Word and Excel Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area Ability to read, analyze and interpret information in medical records and health plan documents Ability to problem solve and identify community resources Possess planning, organizing, conflict resolution, negotiating and interpersonal skills Utilize critical thinking skills, nursing judgement and decision-making skills At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace.-
Case Manager
3 days ago
North Las Vegas, Nevada, United States North Vista Hospital Full timeAbout North Vista HospitalAt North Vista Hospital, our dedicated team of healthcare professionals is committed to delivering high-quality patient care and promoting a culture of excellence. As a member of Prime Healthcare, a Top-15 hospital system in the United States, we are actively seeking new members to join our award-winning team.Our hospital is an...
-
Case Manager
3 months ago
Houston, United States Nexus Health Systems Ltd Full timeJob DescriptionJob DescriptionThe Case Manager is responsible for directing and coordinating the functions and activities of health care services delivery and discharge planning with the multidisciplinary team. The Case Manager facilitates communication and coordination between the health care team members involving both the resident and family in the...
-
Case Manager
2 months ago
Houston, United States Memorial Hermann Health System Full timeAt Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed...
-
Case Manager
2 months ago
Houston, United States Memorial Hermann Health System Full timeAt Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed...
-
RN Case Manager
1 month ago
houston, United States Good Shepherd Hospice Full timeRN Case ManagerRN Case Manager Department: Clinical Employment Type: Full Time Location: Houston, TX Reporting To: Patient Care Manager Description Good Shepherd Hospice is seeking a compassionate candidate for a Register Nurse Case Manager serving patients and their families in Pasadena, Baytown, Pearland with expansion to Texas City and...
-
Case Mgr
3 weeks ago
Houston, United States Interim HealthCare Full timeCase Mgr - RN RN Case Manager Home Health-Galveston TX Pearland, TX Interim HealthCare, one of the nation's leading providers of home care, is now seeking an RN Case Manager in the Galveston, TX area to join the team. Expand your career and apply today! Benefits at Interim Healthcare for Case Managers Competent and reliable in- office clinical support team....
-
Case Manager
2 months ago
Houston, United States Memorial MRI & Diagnostic Full timeJob Type Full-time Description Under general supervision administrative personnel, the Case Manger will liaise with the attorneys and record retrieval personnel. Coordinate to ensure that the care plan to treat the patients is carried out properly and that it has the desired result. JOB FUNCTIONS Case Managers are responsible for the maintenance, compliance,...
-
Case Mgr
1 month ago
Houston, United States Interim HealthCare Full timeCase Mgr - RN Interim HealthCare, one of the nation's leading providers of home care, is now seeking an RN Case Manager in the Humble, Tx area to join the team. Expand your career and apply today! Benefits at Interim Healthcare for Case Managers Competent and reliable in- office clinical support team. Weekly pay. Supplies delivered to your home plus...
-
Registered Nurse Case Manager
3 days ago
Houston, Texas, United States HCA Houston Healthcare Medical Center Full timeJob SummaryThe Registered Nurse Case Manager is a vital member of our healthcare team, responsible for coordinating patient care and ensuring seamless transitions throughout the continuum of care. This role requires a strong understanding of medical necessity, patient needs, and resource utilization.Key ResponsibilitiesCollaborate with healthcare...
-
Temporary Bilingual Patient Advocate
2 days ago
Houston, United States Elevate Patient Financial Solutions Full timeElevate Patient Financial Solutions has an exciting career opportunity available as a Bilingual Patient Advocate. This position will be located in a hospital setting in downtown Houston, TX. This position is Temporary with the ability to transition to Permanent after 6 months. The full-time schedule for this role will be Sunday-Thursday 12pm-8:30pm.Job...
-
Regional Float Case Manager RN
4 weeks ago
houston, United States Kindred Hospital Houston Medical Center Full timeRegional Float Case Manager RNResource Case Manager will cover the Texas, Oklahoma, New Mexico and Arizona locations. Job Summary: The Resource Case Manager serves as a subject matter expert in case management, offering operational expertise within the case management departments across multiple Kindred hospitals. Coordinates and facilitates the care of the...
-
Case Manager- Healthcare
2 months ago
Houston, United States 77 Consultants Full timePrincipal Accountabilities Coordinates/facilitates patient care progression throughout the continuum. Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care. Addresses/resolves system problems impeding diagnostic or treatment progress....
-
Case Manager- Healthcare
2 months ago
Houston, United States 77 Consultants Full timeJob DescriptionJob DescriptionPrincipal AccountabilitiesCoordinates/facilitates patient care progression throughout the continuum.Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care.Addresses/resolves system problems impeding...
-
Director, Case Management
2 months ago
Houston, United States HR Recruiting Services Full timeJob DescriptionJob DescriptionThe Director of Case Management is responsible and accountable for the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.Principal...
-
Case Manager II
3 months ago
Houston, United States Encompass Health Full timeJob DescriptionJob DescriptionEncompass Health Rehabilitation Hospital The VintageFull-Time and PRN opportunities available. Case Manager Career OpportunityRecognized for your abilities as a Case ManagerAre you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just...
-
Director, Case Management
2 weeks ago
Houston, United States Offshore Staffing Full timeJob Description The Director of Case Management is responsible and accountable for the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning. The Director is responsible for...
-
Director, Case Management
1 month ago
Houston, United States Veracity Full timeDirector, Case Management - Houston, TX 77030 Must-Haves RN they also need to have one of the following certifications: CCM/ACM/FAACM Current and valid license to practice as a Registered Nurse in the state of Texas Minimum five (5) years experience in utilization management, case management, discharge planning or other cost/quality management program Three...
-
Director Of Case Management
4 weeks ago
Houston, United States i4 Search Group Healthcare Full timeJob DescriptionJob DescriptionAcute Care Director of Case Management ( MSW) or ( BSN)POSITION TYPE: Registered Nurse (RN)SPECIALTY UNIT: Director of Case ManagementLOCATION:SHIFT:JOB TYPE: Full-Time PermanentJob Description and Responsibilities:We are in search of a great Director of Case Management to run an office with a great team.This role requires a...
-
RN Case Manager
2 weeks ago
Houston, TX, United States Good Shepherd Hospice Full timeRN Case Manager RN Case Manager Department: Clinical Employment Type: Full Time Location: Houston, TX Reporting To: Patient Care Manager Description Good Shepherd Hospice is seeking a compassionate candidate for a Register Nurse Case Manager serving patients and their families in Pasadena, Baytown, Pearland with expansion to Texas City and...
-
Director, Case Management
1 month ago
Houston, Texas, United States Surf Search Full timeCandidates must have 5yrs. plus of Case Management Acute Care Hospital Leadership/Supervisory/Director Experience.The Director of Case Management is responsible and accountable for the implementation of the case management program at the local level.The components/roles of the inpatient case management program consist of the following: Care Facilitation,...