Notifications

Are you open to new opportunities?

Upload your resume to increase your chances of getting noticed.

EmblemHealth
3.1
Care Manager, Concurrent Review (Remote)
New York, NY
$68K - $119K (Employer provided)
Maintain an understanding of utilization management, program objectives and design, implementation, management, monitoring, and reporting.…
30d+
care manager jobs in New York, NY New York, NY jobs EmblemHealth jobs in New York, NY
EmblemHealth salaries care manager salaries in New York, NY
Employee reviews at EmblemHealth EmblemHealth interview experience Working at EmblemHealth
CorVel
2.7
Telephonic Case Manager I
Nottingham, MD
$64K - $95K (Employer provided)
Easy Apply
URAC recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) required to be obtained within 3 years of hire if no……
30d+
case manager jobs in Nottingham, MD Nottingham, MD jobs CorVel jobs in Nottingham, MD
CorVel salaries case manager salaries in Nottingham, MD
Employee reviews at CorVel CorVel interview experience Working at CorVel
Managed Resources
3.1
Clinical Documentation Specialist
Remote
$32.00 - $45.00 Per Hour (Employer provided)
Our team members review medical record documentation and apply clinical criteria and guidelines to ensure comprehensive documentation of patient care, quality……
4d
clinical data manager jobs in Remote Remote jobs Managed Resources jobs in Remote
Managed Resources salaries clinical data manager salaries in Remote
Employee reviews at Managed Resources Managed Resources interview experience Working at Managed Resources
Monogram Health
2.5
Market Physician Executive (MPE)
Brunswick, GA
$189K - $352K (Glassdoor est.)
Easy Apply
Active, unrestricted state medical license required in each state within the market. Current state medical license without restrictions to practice and free of……
30d+
Monogram Health
2.5
Market Physician Executive (MPE)
Atlanta, GA
$200K - $374K (Glassdoor est.)
Easy Apply
Active, unrestricted state medical license required in each state within the market. Current state medical license without restrictions to practice and free of……
30d+
Monogram Health
2.5
Market Physician Executive (MPE) - Float
Savannah, GA
$158K - $295K (Glassdoor est.)
Easy Apply
Active, unrestricted state medical license required in each state within the market. Current state medical license without restrictions to practice and free of……
30d+
Monogram Health
2.5
Market Physician Executive (MPE) - Savannah, GA
Savannah, GA
$132K - $246K (Glassdoor est.)
Easy Apply
Active, unrestricted state medical license required in each state within the market. Current state medical license without restrictions to practice and free of……
30d+
Monogram Health
2.5
Market Physician Executive (MPE) - Float
Georgia
Easy Apply
Active, unrestricted state medical license required in each state within the market. Current state medical license without restrictions to practice and free of……
30d+
Monogram Health
2.5
Market Physician Executive (MPE) - Float
Georgia
Easy Apply
Active, unrestricted state medical license required in each state within the market. Current state medical license without restrictions to practice and free of……
30d+
Monogram Health
2.5
Market Physician Executive (MPE) - Atlanta, GA
Atlanta, GA
$196K - $366K (Glassdoor est.)
Easy Apply
Active, unrestricted state medical license required in each state within the market. Current state medical license without restrictions to practice and free of……
30d+
Memorial Health
3.5
Utilization Review RN
Springfield, IL
$32.95 - $52.73 Per Hour (Employer provided)
Performs clinical review of patient records to evaluate the utilization of acute care services. Minimum of 3- 5 years of recent acute care and/or home health……
30d+
The Guthrie Clinic
3.8
RN Acute Case Manager - System Care Management - FT
Sayre, PA
Easy Apply
Individual consideration may be given to a registered nurse, with significant clinical experience, who holds a bachelor’s degree in a related field.…
30d+
State of Missouri
2.7
Associate/Social Services Specialist (I/II/III)
Columbia, MO
$45K - $52K (Employer provided)
Bachelor’s degree from an accredited college or university, preferably a degree in Social Work or comparable human services field (Substitutions allowed); and,……
7d
Immanuel
4.1
CDI Specialist
Omaha, NE
$50K - $75K (Glassdoor est.)
Must possess valid medical coding certification in one of the following areas: Collaborate with Director to develop fully informed views and insights into the……
30d+
Mohawk Valley Health System
2.8
Inpatient Social Worker LMSW/LCSW/LMHC - Full Time - Days
Utica, NY
$27.00 - $45.00 Per Hour (Employer provided)
Under the clinical direction and administrative supervision by the Behavioral Health Supervisor/Director of Behavioral Health, responsible for providing……
12d
Southcentral Foundation
3.6
Case Management Support I, II - VNPCC Dental
Wasilla, AK
$19.71 - $26.89 Per Hour (Employer provided)
Easy Apply
SCF Human Resources must receive certification before applicants receive preference. This position has two (2) levels designed to provide progressively more……
30d+
Community Options
2.5
Board Certified Analyst (BCBA) - Specialized Enhanced Supportive Housing (SESH)
Smyrna, TN
$55.00 - $60.00 Per Hour (Employer provided)
Easy Apply
Employee must cooperate with the license and department staff in any inspection, inquiry, or investigation. Paid certification and licensure renewals.…
30d+
Personal Injury Law Office
Case Manager / 1 Year Experience is required / Spanish Required.
Van Nuys, CA
$30.00 - $35.00 Per Hour (Employer provided)
Easy Apply
Legal Assistant must have at least 1 year of of prior experience in a plaintiff's personal injury firm; must be a self-starter and be able to work independently……
30d+
Huvepharma, Inc.
Biological Development Manager
Lincoln, NE
$120K - $180K (Employer provided)
Easy Apply
Bachelor’s Degree in a relevant scientific field (Biology, Microbiology, Molecular Biology, Biochemistry, or related) with a minimum of 10 years of industry……
4d
Infiltrator Water Technologies
3.8
Project Manager II
Sutherlin, OR
$74K - $99K (Glassdoor est.)
Must be able to meet and maintain Orenco's approved driver criteria; a valid driver's license, satisfactory driving record, current insurance on personal……
30d+
VMA Electric Inc.
Senior Project Manager
Marlborough, MA
$90K - $125K (Employer provided)
Easy Apply
Travels to project sites across Central Massachusetts; valid driver’s license required. Valid Massachusetts driver’s license required.…
30d+
CHRISTUS Health
3.5
Radiation Therapist - Oncology Radiation Therapy - Full Time
Alexandria, LA
Demonstrates the skill and abilities to accurately assess whether or not simulated procedures can be performed or reproduced on the linear accelerator/simulator……
24h
Texas Panhandle Centers
3.1
Case Manager I-III Dumas Adult BH [1309]
Dumas, TX
$41K - $46K (Employer provided)
Must have a valid Texas driver’s license and be insurable under agency vehicle policy. Bachelor’s degree from an accredited university with a major in……
30d+
State of Missouri
2.7
Associate/Social Services Specialist (I/II/III)
Mexico, MO
$45K - $52K (Employer provided)
Bachelor’s degree from an accredited college or university, preferably a degree in Social Work or comparable human services field (Substitutions allowed); and,……
6d
NeuroPsychiatric Hospitals
3.0
Utilization Review Coordinator
Huber Heights, OH
$50K - $68K (Glassdoor est.)
Maintains knowledge of current trends and developments in the field by reading appropriate books; journals and other literature and attending related seminars……
30d+
CHRISTUS Health
3.5
Registered Nurse Coordinator - Chemotherapy
Santa Fe, NM
Hold a valid NM RN license. Utilize quality improvement tools, including root cause analysis, to investigate fallouts and generate action plans.…
4d
Elevance Health
3.4
LTSS Service Coordinator - Case Manager (Region I: Miami-Dade/Monroe County)
Miami, FL
$44K - $68K (Glassdoor est.)
Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires,……
12d
Fatbeam
3.8
Construction Manager - FTTH (Fiber to the Home) *MUST BE LOCATED IN BOISE, ID
Boise, ID
$70K - $90K (Employer provided)
Easy Apply
Education: Bachelor’s degree in Construction Management, Civil Engineering, or a related field preferred (or equivalent field experience).…
30d+
ImOn Communications
3.8
Infrastructure Access & Utility Coordinator
Cedar Rapids, IA
$52K (Employer provided)
Valid driver’s license with a driving record that allows for you to be insured by ImOn’s insurance carrier. Company-provided tools, uniforms, and vehicle for……
17d
Austin General Contracting
3.8
GC Construction Estimator
Las Vegas, NV
$75K (Employer provided)
Easy Apply
In-depth knowledge of estimating, project management, and field construction practices. Ability to price design-build, design-bid, GMP, and lump-sum projects.…
24d

EmblemHealth

3.1

Care Manager, Concurrent Review (Remote)

New York, NY

$68K - $119K (Employer provided)

Is your resume a good match?

Use AI to find out how well the skills on your resume fit this job description.

Summary of Position

Perform clinical reviews within the Medical Management Operations Concurrent Review utilization management department.
Ensure accurate administration of benefits, execution of clinical policy and timely access to appropriate levels of care.

Principal Accountabilities

Under the direction of the leader, is responsible for the execution of efficient departmental processes designed to manage inpatient utilization within the benefit plan.
Act as the clinical coordinator collaborating with members and facilities to evaluate member needs within the inpatient setting.
Establish and maintain active working relationships with assigned facility care managers/utilization management departments to facilitate appropriate clinical reviews and patient care.
Enter and maintain documentation in the TPH platform meeting defined timeframes and performance standards.
Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA and business standards.
Review and investigate member and provider requests to determine appropriate utilization of benefits and/or claim adjudication.
Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making coverage determinations and recommendations.
Prepare and present clinical case summaries in routine inpatient rounds.
Maintain an understanding of utilization management, program objectives and design, implementation, management, monitoring, and reporting.
Identify quality, cost and efficiency trends and provide solution recommendations to Supervisor/Manager.
Actively participate on assigned committees.
Perform other related projects and duties as assigned.

Qualifications

Education, Training, Licenses, Certifications

Associate’s degree or bachelor’s degree in nursing.
Valid RN License without restriction.
May require a CME accreditation in specific specialties.
Certification in utilization or care management preferred

Relevant Work Experience, Knowledge, Skills, and Abilities

4 – 6+ years of Nursing experience.
Case and/or utilization management/care coordination and managed care experience.
Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience.
Organizing and prioritizing skills, and strong attention to detail.
Trained in the use of Motivational Interviewing techniques.
Experience working in physician practice and/or with electronic medical records.
Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.).
Proficiency with the use of mobile technology (Smartphone, wireless laptop, etc.).

Additional Information

Requisition ID: 1000002996
Hiring Range: $68,040-$118,800

See company reviews

Base pay range

The minimum salary is $68K and the max salary is $119K.

$68K – $119K/yr (Employer provided)

$93K

/yr Median

New York, NY

If an employer includes a salary or salary range on their job, we display it as "Employer Provided". If a job has no salary data, Glassdoor displays a "Glassdoor Estimate" if available. To learn more about "Glassdoor Estimates," see our FAQ page.

Working here doesn’t have to be a secret

3.1

Recommend to a friend
Approve of CEO
CEO: Bill Voigt
11 Ratings

EmblemHealth

3.1

Care Manager, Concurrent Review (Remote)

New York, NY

$68K - $119K (Employer provided)

EmblemHealth

3.1

Care Manager, Concurrent Review (Remote)

New York, NY

$68K - $119K (Employer provided)

Is your resume a good match?

Use AI to find out how well the skills on your resume fit this job description.

Summary of Position

Perform clinical reviews within the Medical Management Operations Concurrent Review utilization management department.
Ensure accurate administration of benefits, execution of clinical policy and timely access to appropriate levels of care.

Principal Accountabilities

Under the direction of the leader, is responsible for the execution of efficient departmental processes designed to manage inpatient utilization within the benefit plan.
Act as the clinical coordinator collaborating with members and facilities to evaluate member needs within the inpatient setting.
Establish and maintain active working relationships with assigned facility care managers/utilization management departments to facilitate appropriate clinical reviews and patient care.
Enter and maintain documentation in the TPH platform meeting defined timeframes and performance standards.
Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA and business standards.
Review and investigate member and provider requests to determine appropriate utilization of benefits and/or claim adjudication.
Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making coverage determinations and recommendations.
Prepare and present clinical case summaries in routine inpatient rounds.
Maintain an understanding of utilization management, program objectives and design, implementation, management, monitoring, and reporting.
Identify quality, cost and efficiency trends and provide solution recommendations to Supervisor/Manager.
Actively participate on assigned committees.
Perform other related projects and duties as assigned.

Qualifications

Education, Training, Licenses, Certifications

Associate’s degree or bachelor’s degree in nursing.
Valid RN License without restriction.
May require a CME accreditation in specific specialties.
Certification in utilization or care management preferred

Relevant Work Experience, Knowledge, Skills, and Abilities

4 – 6+ years of Nursing experience.
Case and/or utilization management/care coordination and managed care experience.
Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience.
Organizing and prioritizing skills, and strong attention to detail.
Trained in the use of Motivational Interviewing techniques.
Experience working in physician practice and/or with electronic medical records.
Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.).
Proficiency with the use of mobile technology (Smartphone, wireless laptop, etc.).

Additional Information

Requisition ID: 1000002996
Hiring Range: $68,040-$118,800

See company reviews

Base pay range

The minimum salary is $68K and the max salary is $119K.

$68K – $119K/yr (Employer provided)

$93K

/yr Median

New York, NY

Working here doesn’t have to be a secret

3.1

Recommend to a friend
Approve of CEO
CEO: Bill Voigt
11 Ratings

Are you open to new opportunities?

13,380 Case Manager I, Concurrent Review jobs in United States

Base pay range

Working here doesn’t have to be a secret

Base pay range

Working here doesn’t have to be a secret