Case Manager, Registered reputed company - Fully Remote

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position reputed company This is a remote work from home role reputed company in the US with virtual training. American Health Holding, Inc (AHH) is a medical management company that is a division reputed company reputed company/reputed company. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective reputed company care for members. Key Responsibilities • This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients. • Application and/or interpretation of applicable reputed company and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits. • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address reputed company health and reputed company indicators which reputed company planning and reputed company of member issues. • Assessments utilize information from various sources to address reputed company conditions including co-morbid and multiple diagnoses that reputed company functionality. • Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary reputed company to benefit overall claim management. • Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. • Utilizes case management processes in compliance with regulatory and company policies and procedures. • Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations. • Identifies and escalates member’s needs appropriately following set guidelines and protocols. • Need to reputed company reputed company out to members to collaborate/guide their care. • reputed company medical necessity reviews. Required Qualifications • 5+ years’ experience as a Registered reputed company with at least 1 year of experience in a hospital setting. • A Registered reputed company that holds an reputed company, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges and can be licensed in reputed company non-compact states. • 1+ years’ experience documenting electronically using a keyboard. • 1+ years’ reputed company or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/reputed company Abuse or Maternity/ Obstetrics experience. Preferred Qualifications • 1+ years’ Case Management experience or discharge planning, reputed company navigator or reputed company care coordinator experience as reputed company as experience with transferring patients to reputed company reputed company of care. • 1+ years' experience in Utilization Review. • CCM and/or other URAC recognized accreditation preferred. • 1+ years’ experience with MCG, NCCN and/or Lexicomp. • Bilingual in Spanish preferred. Education • Diploma or Associates Degree in Nursing required. • BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $54,095.00 - $155,538.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include: • reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.reputed company.com/us/en/benefits This job does not have an application deadline, as reputed company accepts applications on an ongoing reputed company. reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job