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Registered Nurse Case Manager

St. Vincents Home Health, LLC Birmingham ,AL

Fulltime RN Case Manager - Jefferson countySt. Vincent's Home Health & Hospice, an Ascension Health at Home Company, is growing and an immediateRN / Registered Nurse opportunity. Fulltime RN Case Manager

Posted on September 24, 2017

Fulltime RN Case Manager - Jefferson county St. Vincent's Home Health & Hospice, an Ascension Health at Home Company, is growing and an immediate RN / Registered Nurse opportunity. * Fulltime RN Case Manager - Jefferson County* POSITION SUMMARY: Primary functions are to plan, develop, implement, evaluate, organize and direct home care services with the interdisciplinary team including physician, patient/family, and referring agency; and administer skilled nursing care for clients of all ages in their place of residence and assume the responsibility for the total provision of care. Essential Duties and Responsibilities: <ul><li>Assesses home health patients to identify the physical, psychosocial, and environmental needs as evidenced by documentation, clinical record, case conference, team report, and evaluations </li><li>Case manages and provides clinical oversight and direction to the interdisciplinary team, physician, and family </li><li>Implements/develops/documents the plan of care and revises as necessary </li><li>Provides care utilizing infection control measures that protect both the staff and the patient (OSHA) </li><li>Supervises and provides directions to the HHA/LVN to ensure quality and continuity of services provided </li><li>Assures continuity of quality patient care delivered with appropriate documentation </li><li>Monitors assigned cases to ensure compliance with requirements of third party payors </li><li>Performs on-call responsibilities and provides on-call service to patients/families, as assigned </li><li>Provides effective communication to patient/family, team members, physicians, and other health care professionals </li><li>Adheres to all company policies and procedures. </li><li>Adherence to and compliance with information systems security is everyone's responsibility. It is the responsibility of every computer user to: Know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered.Report information systems security problems. </li></ul> Non-Essential Duties and Responsibilities: <ul><li>Perform other duties as assigned.</li></ul> Minimum Qualifications: Education/Licensing/Certification: <ul><li>Graduate of an accredited college/university, Associate, Diploma, or Baccalaureate School of nursing </li><li>Current, unencumberedState License as a registered Nurse </li><li>Current Driver's License </li><li>Current CPR, negative TB screen and Hepatitis consent/declination Experience: </li><li>Two years of experience as a registered nurse in a clinical care setting, home health preferred. Knowledge and Skills: </li><li>Nursing skills as defined as generally accepted standards of practice. </li><li>Good interpersonal skills. </li></ul> Associated topics: ambulatory, bsn, cardiothoracic, domiciliary, intensive, intensive care unit, nurse rn, surgery, surgical, tcu<img src="http://www.jobg8.com/Tracking.aspx?gg%2fxTfnzgNVaYwmtgQJlDgw" width="0" height="0" />

Registered Nurse Case Manager

Care First Hospice, LLC Birmingham ,AL

Fulltime RN Case Manager - Hospice Division Jefferson countyRN Case Manager Hospice - Fulltime St. Vincent's Home Health & Hospice, an Ascension at Home Company, is growing and has an immediate

Posted on September 23, 2017

Fulltime RN Case Manager - Hospice Division Jefferson county RN Case Manager Hospice - Fulltime St. Vincent's Home Health & Hospice, an Ascension at Home Company, is growing and has an immediate RN / Registered Nurse opportunity. Primary functions are to plan, develop, implement, evaluate, organize and direct home care services with the interdisciplinary team including physician, patient/family, and referring agency; and administer skilled nursing care for clients of all ages in their place of residence and assume the responsibility for the total provision of care. Join a team that's making a difference; We offer: <ul><li>Competitive Salary/Benefits</li><li>Inspiring Work</li><li>Spiritually centered</li><li>Sign-on Bonus</li></ul> Find your next career opportunity at www.ahah.net Essential Duties and Responsibilities: <ul><li>Assesses home health patients to identify the physical, psychosocial, and environmental needs as evidenced by documentation, clinical record, case conference, team report, and evaluations</li><li>Case manages and provides clinical oversight and direction to the interdisciplinary team, physician, and family</li><li>Implements/develops/documents the plan of care and revises as necessary</li><li>Provides care utilizing infection control measures that protect both the staff and the patient (OSHA)</li><li>Supervises and provides directions to the HHA/LVN to ensure quality and continuity of services provided</li><li>Assures continuity of quality patient care delivered with appropriate documentation</li><li>Monitors assigned cases to ensure compliance with requirements of third party payors</li><li>Performs on-call responsibilities and provides on-call service to patients/families, as assigned</li><li>Provides effective communication to patient/family, team members, physicians, and other health care professionals</li><li>Adheres to all company policies and procedures.</li><li>Adherence to and compliance with information systems security is everyone's responsibility. It is the responsibility of every computer user to: Know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered. Report information systems security problems.</li></ul> Minimum Qualifications: Education/Licensing/Certification: <ul><li>Graduate of an accredited college/university, Associate, Diploma, or Baccalaureate School of nursing</li><li>Current, unencumberedState License as a registered Nurse</li><li>Current Driver's License</li><li>Current CPR, negative TB screen and Hepatitis consent/declination</li></ul> Experience: <ul><li>Two years of experience as a registered nurse in a clinical care setting, home health preferred.</li></ul> Knowledge and Skills: <ul><li>Nursing skills as defined as generally accepted standards of practice.</li><li>Good interpersonal skills.</li></ul> Associated topics: ambulatory, intensive, intensive care, maternal, nurse, nurse rn, psychatric, recovery, tcu, unit

Field Nurse Case Manager III

York Risk Services Birmingham ,AL

Job Description: JOB SUMMARY: The Medical Case Manager provides medical and vocational assistance and coordination services to assist injured workers in reaching maximum medical improvement and return to work. The Medical

Posted on September 23, 2017

Job Description **JOB SUMMARY:** The Medical Case Manager provides medical and vocational assistance and coordination services to assist injured workers in reaching maximum medical improvement and return to work. The Medical Case Manager facilitates communication between all parties including the injured worker, the adjuster, the employer, treating physician(s) and ancillary providers to assist the injured worker in obtaining prompt and appropriate medical treatment. The Medical Case Manager assesses rehabilitation needs and makes appropriate recommendations. The ultimate goal is for the injured worker to recover and return to work as soon as is medically appropriate. The Medical Case Manager facilitates any temporary or permanent job modifications necessary to allow the injured worker to return to work within the applicable physical restrictions assigned by the doctor. The exact role the Medical Case Manager plays will vary with the injury management model used by each customer. The responsibilities on each case may vary. **ESSENTIAL JOB RESPONSIBILITIES:** * Maintains regular contact with all parties involved to facilitate communication and to provide medical and vocational management and coordination services * Arranges for prompt and appropriate medical treatment of an injured worker by qualified providers (choice of providers as per regulations); Schedules appointments to avoid delays in treatment by primary care physicians, specialists or ancillary services * Assists the treating physician in developing a written treatment plan for the injured worker, including the identity and scope of treatment by any other providers to which referrals have been made. Work with the medical providers to track progress and to modify the treatment plan as necessary until maximum medical improvement is achieved * Obtains medical reports and required work status forms. Ensures all parties receive appropriate reports * Facilitate authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment as per regulations to ensure appropriate treatment is not delayed * Cooperates with the treating physician to obtain a full or conditional release to return to work before injury becomes a lost time claim; Work with the treating physician to update any conditions as medical treatment progresses * Assesses the injured worker and his/her support system and family; Makes appropriate referrals throughout the continuum of care including educational, financial, and psychological or other human services as indicated * Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return to his/her full pre-injury employment; The job must be consistent with any physical restrictions assigned by the treating doctor; Educates the employer on the tangible and intangible benefits of accommodating the injured worker to keep him in the work force * Where a return to work with the same employer is not possible, provide vocational services to the injured worker to identify vocational goals and develop an early return to work plan * Maintains constant contact with the adjuster assigned to the file through telephone calls, EMAIL and written reports. For each customer be aware of the limits of decision-making authority delegated by the adjuster to the case manager and respect these limits. Satisfy the documentation and reporting requirements of each customer * Makes appropriate use of Wellcomp physicians for adjuster support, peer-to-peer consultation and as professional resource; Make appropriate use of Wellcomp clinical and information systems staff to deliver exceptional service to direct & indirect customers * Organizes and review medical records to identify specific medical issues; Provides information and recommendations to appropriate parties * Acts as an advocate for the injured worker with all parties while maintaining the injured worker’s privacy and safety; Adheres to Wellcomp's confidentiality policies and procedures. Follows ethical, legal, and regulatory standards * Participates in the collection of outcome information and Wellcomp’s Quality Improvement process to determine the impact of case management activities on timely injury recovery, medical treatment, return to work, claim costs, and both injured worker and client satisfaction. The result achieves desirable outcomes for all * Maintains continuing education requirements per state license requirements. Maintains an updated and working knowledge of workers’ compensation and federal laws that impact the delivery of health care and return to work * Become proficient in the software used in the department * Contribute to the success of the company and its posture toward customer service by a positive and professional attitude and by understanding and responding to the needs of our direct and indirect customers; Follows ethical, legal, and regulatory standards * Performs other duties as assigned **SUPERVISORY RESPONSIBILITIES:** * The Medical Case Manager reports to the Team Manager, Case Management and has no direct reports. Required Skills **KNOWLEDGE: SKILLS/ABILITIES** * The ability to work effectively with minimal direct supervision * The ability to plan and use time effectively * The ability to work as a member of the Wellcomp team * Must be computer literate * Keyboard typing and dialing of telephone require hand dexterity and the repetitive use of finger movement * Due to the nature of the position, sitting in a sustained position for prolonged periods may be necessary * Vision must be adequate to view the computer screen * This may include occasional air travel and overnight stays * Must have the ability and willingness to travel for task and/or field case management visits if within assigned geographic areas * Must possess a valid driver’s license; Must provide proof of insurance Required Experience **EDUCATION:** * MA/ BS / BA in Nursing or Associates Degree in Nursing from accredited school with Equivalent Work Experience and a CCM, CIRS, CRRN, COHN or other related designation or; * BA/BS or MA in related field with a CCM, CDMS, or CRC or other related designation or; * Current Nursing license and/or certification * CCM required based on state guidelines. **EXPERIENCE:** * Three or more year’s workers compensation case management experience or related field *Tracking Code:* BIRMINGHAM08291701 *Job Location:* Birmingham, Alabama, United States *Position Type:* Full-Time/Regular

Onsite Nurse Case Manager (Rn)

Genex Services Birmingham ,AL

Overview We are currently seeking an Onsite Nurse Case Manager (RN) for our customer in Birmingham, Alabama. Responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals

Posted on September 23, 2017

Overview We are currently seeking an Onsite Nurse Case Manager (RN) for our customer in Birmingham, Alabama. Responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. Working as an intermediary between carriers, attorneys, medical care providers, employers and employees, you will closely monitor the progress of the injured worker and report results back to the employer and insurance carrier. This will ensure appropriate and cost-effective healthcare services leading to a medically rehabilitated individual who is ready to return to an optimal level of work and functioning. Responsibilities Main responsibilities will include but are not limited to: + Using clinical/nursing skills to help coordinate the individual’s treatment program while maximizing cost containment. + Serving as an intermediary to interpret and educate the individual on his/her disability, and the treatment plan established by the case manager, physicians, and therapists. Explaining physician’s and therapists’ instructions, and answering any other questions the claimant may have in an effort to facilitate his/her return to work. + Working with the physicians and therapists to set up medical assessments to develop an overall treatment plan that ensures cost containment while meeting state and other regulator’s guidelines. + Researching alternative treatment programs such as pain clinics, home health care, and work hardening. Coordinating all aspects of the individual’s enrollment into the programs, and then monitors his/her progress, in an effort to maximize cost containment and minimize time away from work. + Working with employers on modifications to job duties based on medical limitations and the employees functional assessment. Helping employer rewrite a job description, when necessary and possible, in an effort to return the client to the workplace. + May provide testimony on litigated cases. + Coordinates injured workers’ appointments and arranges for transportation as needed. + Documenting and reporting all case activity is critical for accurate case management and billing procedures. + Maintaining all case documents in files ensuring a comprehensive and detailed source of information for all parties involved in the case. + Preparing detailed evaluation reports, as per account guidelines, and case recording documenting for each phase of activity as it is completed. + Maintains phone contact with all parties involved to monitor, update, and advance case activity to ensure the progress of the case. + Completing insurance carrier reports on a monthly (or as required) basis, as well as other necessary paperwork for the insurance company, state, or other regulatory bodies. + Maintaining professionalism at all times despite the stressful demands of the position. Capable of maintaining close relationships among all parties involved both in person and over the phone. Must be readily available for and responsive to all parties concerned. + Acquiring and maintaining knowledge of developments in the medical case management field. Keeping abreast of local workers’ compensation laws and regulations, as well as other issues related to the case management/managed care industry. This is also critically important in keeping licenses and certifications valid. + Participating in professional associations keeps the case manager informed of events in their field while establishing referral contacts. + May assist in training/orientation of new staff as requested. + Other duties may be assigned. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. + Diploma, Associate or bachelors degree in nursing or bachelors degree (or higher) in a health or human services related field required. Masters level and/or advanced study in a health-related field desired. + Minimum of two (2) years full time equivalent of direct clinical care to consumers required. Workers’ compensation-related experience preferred. Prior case management experience preferred. + A current, unrestricted license or certification to practice a health or human services discipline in a state or territory of the United States that allows the health professional to independently conduct an assessment as permitted within the scope of practice of the discipline; or + In the case of an individual in a state that does not require licensure or certification, the individual must have a baccalaureate or graduate degree in social work, or another health or human services field that promotes the physical, psychosocial, and/or vocational well-being of the persons being served, that requires: + A degree from an institution that is fully accredited by a nationally recognized educational accreditation organization; + The individual must have completed a supervised field experience, in case management, health, or behavioral health as part of the degree requirements; and + URAC-recognized certification in case management within four (4) years of hire as a case manager + Pursue URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN) upon eligibility. Other state licenses/certifications as required by law. + Valid driver’s license required. + Experience in rehabilitation services industry, vocational/occupational/industrial nursing preferred. + Background in state workers’ compensation law and practices desirable. + Excellent interpersonal skills, phone manners, and organizational skills. + Ability to set priorities and work independently. + Computer literacy required. Job LocationsUS-AL-Birmingham Job ID2017-1712 CategoryField Case Management

Nurse Case Manager

Cigna Birmingham ,AL

Description: Summary: Coordinates and manages relationships with single office practices to multiple provider practices in HealthSpring’s P4Q or P4Q2programs\. Consistently monitors participating provider performance

Posted on September 23, 2017

**Description:** **Summary:** Coordinates and manages relationships with single office practices to multiple provider practices in HealthSpring’s P4Q or P4Q2programs\. Consistently monitors participating provider performance on the identified P4Q and/or HEDIS STAR measures and regularly communicates status of those measures to the appropriate HealthSpring team members\. Establishes and maintains regularly scheduled contact with designated P4Q or P4Q2Program Point\-of\-Contact in each participating office and conducts on\-site visits in those offices\. Coordinates and ensures that all communication is maximized effectively between the practice, health plan, and any disease management vendors Coordinate and manage member care in participating provider practices: Under general supervision, responsible for identifying medium/ high risk members by utilizing predictive modeling reports for the assigned physician and/or practice\. Identify gaps in care and document compliance\. Assists in coordinating the delivery of cost\-effective, quality\-based health care services for health plan members by incorporating physician/staff and other health plan services to address individual needs of the member, and awareness of community resources\. Initiate contact with member/family, physician, and health care providers/suppliers to discuss the alternative treatment plan\. Greet members at on\-site visits and assess members that need an ECC visit to assure coordination\. Daily monitors, and evaluates inpatient admissions and discharge census and follows through for post discharge appointments and needs\. Evaluates cases for quality of care\. Partner with in\-office Point\-of\-Contact\(s\) to ensure member compliance and practice success:Coordinate real\-time performance measure management\. Ensure that participating practices are driving improvement on P4Q Program performance measures\. Review data for those members that are frequent users of healthcare resources to ensure they are receiving the proper care\. Suggest physician referrals to case management or behavioral health\. Communicate real\-time updates to identified team members\. Develop and maintain a process to ensure that all members in participating practices receive the screenings and services needed within the given timeframe\. Maintain detailed understanding of all P4Q Program \(HEDIS STAR\) performance measures\. **Qualifications:** USCandidates Only: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status\. If you require a special accommodation, please visit our Careers website or contact us atSeeYourself@cigna\.com\. Minimum Requirements:Registered Nurse in applicable state\. At least one year related experience in a healthcare environment\. Excellent written and oral communication skills; excellent problem solving skills; highly organized and proactive; ability to handle multiple tasks and set priorities; detailed oriented; works independently with minimum of supervision\. Ability to travel to and work at participating practices\. Ability to lift and move 35\-40lbs\. Preferred Requirements:Current licensure as a Registered Nurse \(RN\), or Certified Case Manager in applicable state\. Minimum two years clinical practice experience in a providers’ office, hospital setting\. **Primary Location:** Birmingham\-Alabama **Work Locations:** 2 Chase Corporate Drive STE 300 Birmingham 35244 **Job:** Med Mgt\-\-Case Management **Schedule:** Regular **Shift:** Standard **Employee Status:** Individual Contributor **Job Type:** Full\-time **Job Level:** Day Job **Travel:** Yes, 100 % of the Time **Job Posting:** Sep 8, 2017, 11:43:21 AM

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