6,530 Remote Case Manager Jobs (August 2026) - Apply with AI

Vynca is seeking a dedicated Behavioral Health Case Manager to provide exceptional care for clients with complex needs. This remote role requires collaboration with healthcare providers, family support, and community services to coordinate comprehensive care and promote wellness. Candidates should possess relevant licenses, experience in care management, and strong communication skills, with a preference for bilingual candidates. Join a passionate team committed to transforming care and making a difference in clients' lives.

Posted 1 week ago

Department Name: BMA-D Work Shift: Day Job Category: Clinical Care Better Than Ever for Nurses. When we make things better than ever for nurses at Banner Health, we make things better than ever for all of us. This means investing in the holistic health and happiness of our nurses—through better pay, better benefits, better opportunities and a better community. Join Banner University Family Care's Care Management Team as a DSNP Adult RN Care Manager. Make a meaningful difference in the lives of adults with complex healthcare needs by joining Banner Medicare Advantage as a DSNP Adult RN Care Manager . In this role, you'll provide telephonic complex case management, partnering with members, caregivers, providers, and community resources to coordinate care, overcome barriers, and support the management of chronic and complex medical conditions. Through comprehensive assessment, advocacy, and individualized care planning, you'll help members navigate the healthcare system and access the services and resources they need to achieve their health goals. As a trusted clinical resource and advocate, you'll facilitate seamless transitions across the continuum of care, ensuring members receive high-quality, evidence-based, and person-centered support. You'll collaborate with interdisciplinary teams to promote better health outcomes, enhance quality of life, and empower members to actively participate in their care. If you're passionate about improving adult health outcomes, building strong relationships, and delivering whole-person care, you'll find a rewarding opportunity to create lasting impact while supporting members on their journey to better health and well-being. The RN, Case Manager a remote position with a work schedule of Monday - Friday 8am - 4:30pm. CANDIDATES MUST LIVE IN THE STATE OF ARIZONA TO BE CONSIDERED. Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options, so you can focus on being the best at what you do and enjoying your life. Banner Plans Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position provides comprehensive care coordination for patients as assigned. This position assesses the patients plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patients health care needs. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care. CORE FUNCTIONS 1. Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes. 2. Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes. 3. Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care. 4. Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes. Assesses patient admissions and continued stay utilizing standard criteria. Identifies issues that may delay patient discharge and facilitates resolution of these issues. 5. Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice. 7. May supervise other staff. 8. Has freedom to determine how to best accomplish functions within established procedures. Confers with supervisor on any unusual situations. Positions are entity based with no budgetary responsibility. Internal customers: All levels of nursing management and staff, medical staff, and all other members of the interdisciplinary health care team. External Customers: Physicians and their office staff, payers, community agencies, provider networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse (R.N.) license in state worked. For assignments in an acute care setting, Basic Life Support (BLS) certification is also required. Requires a proficiency level typically achieved with 3-5 years clinical experience. Must have a working knowledge of care management, acute care and/or home care environments, community resources and resource/utilization management. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively in an interdisciplinary team format. For assignments in an acute care setting, must be able to work flexible hours and take rotating call after hours. Banner Registry and Travel positions require a minimum of one year experience in an acute care hospital and/or home care setting. Experience must include working in an acute care and/or home care setting within the past 12 months as a Case Manager in the specialty area. PREFERRED QUALIFICATIONS Certification for CCM (Certified Case Manager) preferred. Additional related education and/or experience preferred. Estimated Pay Range: $35.43 - $59.05 / hour #xa; #xa;Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. #xa; #xa;This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained. #xa; #xa; EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy

Posted 2 weeks ago

Role overview The Medical Director, Care Management leads the care, case, and utilization management programs, setting clinical direction and owning program performance for Included Health's CCM and UM programs. This physician leader is first a strong operator. The person owns outcomes, not just clinical standards, with success defined as the program hitting its performance and quality targets. This role owns a critical program that bends the cost curve: navigating members to high-quality care, educating members about their health, and supporting them during vulnerable moments. Reporting to the Senior Medical Director, Complex Care, they bring a strong, evidence-based point of view, are comfortable operating under ambiguity, and translate organizational priorities into clinical operations that perform at scale. They are responsible for ensuring the programs contribute to clinical outcomes, client commitments, and third-party oversight. This physician leader leads an innovative, fast-moving team at the core of Included Health’s population health strategy. Role overview The Medical Director, Care Management leads the care, case, and utilization management programs, setting clinical direction and owning program performance for Included Health's CCM and UM programs. This physician leader is first a strong operator. The person owns outcomes, not just clinical standards, with success defined as the program hitting its performance and quality targets. This role owns a critical program that bends the cost curve: navigating members to high-quality care, educating members about their health, and supporting them during vulnerable moments. Reporting to the Senior Medical Director, Complex Care, they bring a strong, evidence-based point of view, are comfortable operating under ambiguity, and translate organizational priorities into clinical operations that perform at scale. They are responsible for ensuring the programs contribute to clinical outcomes, client commitments, and third-party oversight. This physician leader leads an innovative, fast-moving team at the core of Included Health’s population health strategy. Key Responsibilities: Clinical and Operational Leadership: Serve as the clinical escalation point for care, case, and utilization management programs. Set and maintain clinical standards, evidence-based care pathways, and clinical quality expectations across the portfolio, using clinical judgment in collaboration with subject matter experts. Own clinical KPIs, including setting targets, evaluating performance gaps, and redesigning workflows to close them. Interrogate the data. Identify outliers or workflows that don't make sense, and drive them to resolution and improvement. Run the program's operating cadence, including weekly performance reviews, escalation triage, and action tracking, to the team accountable to committed targets and timelines. Program Design and Strategy: Evolve the clinical operating model across adult, maternity, and pediatric populations to deliver on Included Health’s population health strategy. Partner with Product and Engineering to design, validate, and deploy AI and agentic tools into clinical workflows, and ensure AI-generated output is valid and actionable. Build new programs and models of care, and define how they scale across populations and clients. People Management: Lead, manage, and develop leaders, setting clear clinical and operational expectations. Conduct performance reviews, coaching, and feedback for direct reports. Attract and retain a strong, diverse pool of clinicians and talent aligned with company vision and goals. Cross-functional Collaboration: Partner with other clinical leaders and cross-functional stakeholders to coordinate care for members with multi-specialty needs. Represent care management in cross-functional initiatives, pilots, and strategic planning related to complex care. In partnership with the Quality team, implement quality assurance processes to ensure consistent, excellent service to members. Qualifications: Required: Education: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO). Clinical Experience: Board certified in internal medicine, family medicine, med-peds, or a related specialty, with a minimum of 7 years of post-residency clinical experience, and the ability to apply that clinical lens to population health leadership. Leadership Experience: Minimum of 5 years in a healthcare leadership role with direct oversight of clinical teams or programs, including experience managing other clinical leaders (managing managers). Licensure: Active, unrestricted medical license in good standing in state of residence, plus active multi-state licensure or willingness to obtain it. Operations and Performance: Track record of delivering against operational KPIs, like productivity, clinical quality, engagement, in a scaled, performance-driven setting. Preferred: Digital Health: Experience working in digital health or virtual care delivery models. Clinical AI: Comfort integrating clinical AI tools into day-to-day workflows and care delivery. Population Health: Knowledge of the medical, behavioral, and social factors that drive poor outcomes and avoidable cost across complex populations. Location: Lives in a physician compact-eligible state. Compensation: The United States new hire base salary target range for this full-time position is: $240,720-368,304+ bonus + equity + benefits Starting base salary for you will depend on several job-related factors, unique to each candidate, which may include education; training; skills; years and depth of experience; certifications and licensure; our needs; internal peer equity; organizational considerations; and understanding of geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and great compensation package based on their roles and locations. Your Recruiter can share your geographic zone upon inquiry. Benefits Perks: In addition to receiving a great compensation package, the compensation package may include, depending on the role, the following and more: -Remote-first culture -401(k) savings plan through Fidelity -Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance) -Paid Time Off ("PTO") and Discretionary Time Off ("DTO") -12 weeks of 100% Paid Parental leave -Family Building Compassionate Leave: Fertility coverage, $25,000 for surrogacy/adoption, and paid leave for failed treatments, adoption or pregnancies. -Work-From-Home reimbursement to support team collaboration home office work Your recruiter will share more about the salary range and benefits package for your role during the hiring process. About Included Health: Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We're on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It's all included. Learn more at includedhealth.com . Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law. #LI-Remote About Included Health Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com . ----- Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.

Posted today

Join an Award-Winning Personal Injury Law Firm At The Ward Law Group, our mission is simple: Changing Lives. One Client at a Time Recognized as one of the Best Places to Work for consecutive years, we are committed to delivering exceptional legal representation while creating an environment where talented professionals can grow, lead, and make a meaningful impact every day. We believe our people are our greatest asset. We foster a collaborative, innovative, and high-accountability culture where every team member is empowered to make informed decisions, continuously improve, and deliver exceptional results for our clients. Every role contributes directly to helping injured individuals navigate one of the most challenging times in their lives while supporting the continued growth and success of our firm. Our Core Values Faith – We act with integrity, honesty, and purpose in everything we do. Accountability – We take ownership of our work, our commitments, and the results we deliver. Leadership – We lead by example, inspire others, embrace continuous improvement, and develop high-performing teams. Loyalty – We build lasting relationships through trust, respect, and dedication to our clients, teammates, and community. Service to Our Clients – We are committed to delivering compassionate, responsive, and exceptional service that maximizes every client's opportunity for success. Service to Our Teammates – We foster a culture of collaboration, respect, support, and shared success where every team member has the opportunity to grow and thrive. Service to Our Community – We believe in making a positive impact beyond the workplace by serving and strengthening the communities where we live and work. If you are passionate about helping injured clients, thrive in a fast-paced, results-driven environment, and are committed to delivering exceptional client service while continuously growing your career, we invite you to join The Ward Law Group and help us change lives—one client at a time. Please submit your resume in English. The Ward Law Group is seeking an experienced Senior Case Manager – Settlements Negotiations to support the settlement process and negotiate personal injury claims under attorney supervision. Manage New York plaintiff personal injury cases from intake through settlement, including insurance communications, medical treatment coordination, claim management, and settlement negotiations. Coordinate with clients, medical providers, insurance carriers, and attorneys to support case progression and resolution. Maintain accurate case documentation and case activity in Litify. Assist with settlement-related activities under attorney supervision. Fluent in English and Spanish. Minimum 2 years of recent plaintiff personal injury case management, negotiations, or settlements experience. Experience handling New York personal injury claims, including familiarity with New York No-Fault, bodily injury (BI), uninsured/underinsured motorist (UM/SUM), and liability claims. Experience working in a plaintiff personal injury law firm, preferably using Litify or Salesforce. Strong organization, communication, negotiation, and case management skills. Disclaimer This position performs settlement and negotiation-related activities under attorney supervision and does not provide legal advice or perform duties requiring a licensed attorney. Benefits Eligible employees enjoy a competitive benefits package, including: Medical, Dental Vision Insurance Company-paid Life Insurance Short-Term Long-Term Disability Supplemental Insurance Options 401(k) with Company Match Paid Time Off Employee Assistance Resources Join Our Team At The Ward Law Group, every role contributes to changing lives. If you're looking for an opportunity where your skills, attention to detail, and dedication to client service can make a meaningful impact, we'd love to hear from you. Apply today and become part of a team committed to excellence, growth, and compassionate client service. Agency Notice The Ward Law Group is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee of The Ward Law Group via email, the internet, or any other method without a valid written Statement of Work for this position will be deemed the sole property of The Ward Law Group. No fee will be paid in the event a candidate is hired as a result of an unsolicited referral or through other means.

Posted 2 days ago

Devoted Medical seeks a Primary Care Social Work Case Manager to support its mission of improving healthcare for vulnerable populations. This role focuses on social work case management within a virtual care platform, emphasizing psychosocial needs and interdisciplinary collaboration. Key responsibilities include telephonic visits, relationship building with patients, emotional support, and various case management interventions. Qualified candidates should have a Master's degree in social work and at least two years of medical experience, preferably in a bilingual context. A commitment to compassionate care and teamwork is essential.

Posted 1 week ago

The Field Nurse Case Manager is a remote position responsible for coordinating care for injured workers, ensuring effective communication among stakeholders, and facilitating treatment and rehabilitation processes. The role requires regular local travel, adherence to case management protocols, and the ability to maintain professional relationships with clients and insurance representatives. Candidates must be a licensed RN with relevant experience in case management.

Posted 1 week ago

As a Transitions of Care Behavioral Health Social Worker, you will provide short-term interventions to members connecting with community-based behavioral health services. Your role focuses on preventing avoidable emergency care and readmissions post-hospitalization. The team emphasizes culturally competent care and fosters a supportive environment to ensure team resilience. Required qualifications include a Master's degree in Social Work and 5 years of relevant experience. Leadership skills, proficiency in assessments, and interdisciplinary collaboration are crucial.

Posted 1 week ago

Job Title: Case Manager Location: South Africa Job Type: Full-Time, Remote Working Hours: US Hours (9am-5pm EST) Salary: South African Rand (ZAR) We are seeking a highly organized, proactive, and detail-oriented Case Manager to join our growing team. This role is responsible for coordinating client services and ensuring families receive seamless support throughout their therapy journey. The Case Manager serves as the primary point of coordination between families, providers, and internal departments, ensuring authorizations, scheduling, documentation, and ongoing client communication are handled efficiently and professionally. We are looking for someone who is sharp, articulate, a quick learner, and able to anticipate challenges before they arise. The ideal candidate thrives in a fast-paced environment, takes ownership of their work, and requires minimal supervision. Key Responsibilities Coordinate client services from intake through ongoing care. Assess client needs and assist in developing and maintaining individualized care plans. Coordinate with healthcare providers, families, and internal teams to ensure seamless communication and continuity of care. Manage client schedules and coordinate with providers to ensure appropriate coverage. Monitor and process insurance authorizations, renewals, and required documentation. Monitor client progress and communicate updates to the appropriate stakeholders, making recommendations or adjustments to care coordination where needed. Educate families on treatment processes, available resources, and support services. Respond to client inquiries promptly while providing professional and compassionate support. Maintain accurate and up-to-date client records, case notes, and documentation. Track outstanding tasks and proactively follow up to ensure timely completion. Identify and resolve scheduling, authorization, or service delivery issues before they impact client care. Advocate for clients by ensuring they have access to the appropriate services and resources. Ensure compliance with company policies, healthcare regulations, and documentation standards. Utilize internal systems and software to manage case information efficiently. Participate in case review meetings and contribute to continuous process improvement initiatives. Collaborate with cross-functional teams to deliver an exceptional client experience. Perform additional administrative and coordination duties as required.

Posted 2 days ago

Inizio Engage has a long-standing partnership with a leading Biotechnology company, across Commercial, Patient Solutions and Medical Affairs businesses. A successful candidate will play a critical role in supporting patient access and reimbursement services, acting as a key liaison between patients, providers, payers, and internal HUB teams. The ideal candidate will demonstrate strong case management capabilities, attention to detail, and a patient-centric approach while navigating complex access and reimbursement processes. This is your opportunity to join Inizio Engage and represent a leading biotechnology company as part of an exciting new product launch bringing innovative therapy options to patients who need them most. Why You’ll Love Working Here We believe great people deserve great support—at work and beyond. That’s why we offer a rewards experience designed to help you thrive personally, professionally, and financially: Competitive pay that recognizes your experience, expertise, and impact Comprehensive benefits including medical, dental, and vision coverage; accrued paid time off; 401(k) with company match; disability and life insurance; and paid maternity and paternity leave Company-paid holidays so you can rest, recharge, and focus on what matters most Recognition programs, contests, and awards that celebrate your contributions Continuous growth opportunities through learning, leadership development, and career advancement support A collaborative culture where your ideas are valued and your work makes a difference We’re also proud to be recognized for creating an exceptional employee experience: Best Place to Work in BioPharma — 2022, 2023, 2025 Certified Great Place to Work® — 2021, 2023, 2025, 2026 Learn more: https://www.greatplacetowork.com/certified-company/7003732 What will you be doing? Manage assigned patient cases from referral through therapy initiation, ensuring timely, accurate, and compliant case progression Conduct benefits investigations electronically or by calling the insurance company to determine coverage information, prior authorization requirements, and patient financial responsibility Manage the prior authorization and appeals process, including obtaining plan-specific criteria and requirements, initiating, submitting, and tracking requests, and following up with plans, patients, and HCPs as needed to ensure timely outcomes. Identify and facilitate patient enrollment in financial assistance programs, including copay and patient assistance programs Support communications with patients, healthcare providers, payers, and specialty pharmacies as needed Provide education on insurance coverage, access pathways, and next steps in the treatment journey when needed Collaborate with internal teams and external partners to ensure timely therapy initiation and adherence to service level agreements Document all case activity accurately within HUB systems in compliance with SOPs and regulatory requirements Monitor case progress and escalate complex reimbursement issues as needed Response to incoming calls from patients/caregivers and prescriber’s offices and addressing or routing calls as needed Support leadership with tracking and resolving escalations Support quality initiatives, audits, and continuous process improvement efforts Ensure compliance with HIPAA, privacy, and regulatory standards at all times What do you need for this position? Bachelor’s Degree or equivalent experience preferred Experience in patient access, HUB services, reimbursement support, specialty pharmacy, or healthcare case management preferred Working knowledge of benefits investigation, prior authorization, appeals, and patient assistance programs Strong communication and interpersonal skills with a patient-focused approach Ability to manage a high volume of cases in a fast-paced environment while meeting service level expectations Proficiency with CRM systems and Microsoft Office applications Strong organizational, analytical, and problem-solving skills Ability to prioritize workload and manage multiple tasks effectively The base pay range for this position is $38K – $70K per year. The final compensation offered to a successful candidate will be determined by factors such as experience, skills, internal equity, and business needs. About Inizio Engage Inizio Engage is a strategic, commercial, and creative engagement partner that specializes in healthcare. Our passionate, global workforce augments local expertise and diverse mix of skills with data, science, and technology to deliver bespoke engagement solutions that help clients reimagine how they engage with their patients, payers, people, and providers to improve treatment outcomes. Our mission is to partner with our clients, improving lives by helping healthcare professionals and patients get the medicines, knowledge and support they need. We believe in our values: We empower everyone/We rise to the challenge/We work as one/We ask what if/We do the right thing, and we will ask you how your personal values align to them. To learn more about Inizio Engage, visit us at: https://inizio.com/ Equal Opportunity Inclusion Inizio Engage is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, gender, gender identity or expression, genetic information, marital status, medical condition (including pregnancy, childbirth, or related conditions), mental or physical disability, national origin, protected family care or medical leave status, race, religion (including beliefs and practices or the absence thereof), sexual orientation, military or veteran status, or any other characteristic protected by applicable federal, state, or local law. Inizio Engage is committed to providing reasonable accommodations in accordance with applicable law. Inizio Engage complies with applicable fair chance hiring laws and will consider qualified applicants regardless of criminal history. Where permitted by applicable law, employment offers may be contingent upon the successful completion of a background check. Any information obtained from a background check will be considered in relation to the requirements of the relevant position, consistent with applicable law. Candidate Use of Artificial Intelligence in Interviews As part of our commitment to a fair and equitable hiring process, candidates are expected to complete all interview activities without the use of artificial intelligence tools or external assistance unless such assistance is authorized in advance by Inizio Engage or otherwise required in accordance with applicable law. This includes, but is not limited to, using generative artificial intelligence platforms to produce, edit, or guide responses in real time. Candidates may be asked to confirm compliance with this policy. Any violation of this policy may result in disqualification from consideration of employment. Candidates may submit requests for reasonable accommodation in accordance with applicable law to the Inizio Engage Talent Acquisition team.

Posted 1 week ago

Join our team as an RN Case Manager, a vital member of our Population Health team, working fully remote and embedded within an interdisciplinary team. Our ideal candidate will engage with members through telephonic outreach, utilizing critical thinking for assessment, planning, and implementation. You will find fulfillment in supporting our members with personalized care coordination, empowering them with tools, education, and self-care coaching to achieve long-term lifestyle changes. This role is designed to improve member outcomes, be cost-effective, and promotes positive operational results. We seek a dedicated, caring, and compassionate individual who is organized, has excellent communication skills, and is proficient with technology. Notes: The RN should hold a compact license CCM certification is not required but is preferred . Business hours are 8-6 EST, with leadership working with each case manager to establish a schedule within these hours, allowing for adjustments to meet member needs. A commitment to leveraging AI-enabled tools and technology to improve efficiency, streamline processes, and support continuous operational improvement. Job Responsibilities Supporting utilization management functions for more complex and non-routine cases as needed. Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs. Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation. Digital positions must have the ability to effectively communicate via digital channels and offer technical support. Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions. Various immunizations and/or associated medical tests may be required for this position. This job requires digital literacy assessment. Job Qualifications License Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience 3 years - Clinical experience required 5 years - Experience in the health care industry For Select Community Katie Beckett: 2 years experience in IDD for Select Community is required Skills\Certifications Excellent oral and written communication skills PC Skills required (Basic Microsoft Office and E-Mail) Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Posted 1 week ago

Point C is seeking a dedicated Case Management Nurse to improve patient health outcomes. This position serves as a liaison between patients, healthcare providers, and community resources, focusing on continuity of care and adherence to treatment. Responsibilities include developing treatment plans, maintaining clinical reports, and enhancing patient self-management. Qualifications include being a registered or licensed practical nurse with significant clinical or case management experience. Compensation is competitive with potential bonuses.

Posted 1 week ago

We are hiring a Home Health Case Manager at BCBST! In this role, you will support TennCare (Medicaid) members with complex medical, functional and social needs. You will coordinate home and community-based care, conduct required home visits, and support members transitioning to adult benefits. You’ll collaborate closely with providers and internal care teams using digital tools to identify care gaps, reduce hospitalization risk, and improve outcomes. To be successful in this role, in addition to the core job requirements, you'll bring strong clinical judgement, experience using digital tools to communication, and availability for home visits. You will be a strong candidate for this role if you have the following: home health or hospice nursing experience, pediatric experience, knowledge of MTLSS programs, and familiarity with community-based services. Note: This is a remote, Monday–Friday (8:00 a.m.–5:00 p.m.) role with flexibility to support member needs, however this role requires traveling to members' homes monthly in the Nashville area. Candidates must live within 50 miles of Nashville. Sponsorship is not available for this role Job Responsibilities Supporting utilization management functions for more complex and non-routine cases as needed. Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs. Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation. Digital positions must have the ability to effectively communicate via digital channels and offer technical support. Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions. Various immunizations and/or associated medical tests may be required for this position. This job requires digital literacy assessment. Job Qualifications License Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience 3 years - Clinical experience required 5 years - Experience in the health care industry For Select Community Katie Beckett: 2 years experience in IDD for Select Community is required Skills\Certifications Excellent oral and written communication skills PC Skills required (Basic Microsoft Office and E-Mail) Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Posted 3 days ago