Jobs in the United States

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Added 1 min ago
D
Supervisor
DSV
Taylor, TX
- $72,000 USD / year
…Applies sound communication and motivational techniques, create programs to fairly and equitably supervise, counsel, and (where needed) discipline team members. Provides direction and…
Added 1 min ago
Count Drop Team Supervisor
Soboba Casino
San Jacinto, CA
The Count Drop Team Supervisor willprovide leadership and professional development for the Count Drop Team. The Count Drop Team Supervisor will also be responsible for the accuracy of the…
Added 2 mins ago
Per Diem, Employee Health Nurse
Main Line Health
PA
Develop and Grow your Career! At MLH, you are encouraged to attend MLH Education & Development Classes that offer a variety of relevant courses, tools, and resources to help achieve your…
Added 2 mins ago
Senior Cost Manager / Quantity Surveyor - Life Sciences Construction
Turner & Townsend
Charlottesville, VA
Turner & Townsend is a global professional services company with over 22,000 people in more than 60 countries.
Added 3 mins ago
Assistant Store Manager
The Vitamin Shoppe
Columbus, GA
Looking to fine tune your leadership skills in an environment that fosters continuous education and professional development? Are you committed to helping others become their best selves,…
Added 5 mins ago
HR Business Manager
Youth Opportunity Investments, LLC
Rockdale, TX
Tuition reimbursement and professional development
Added 6 mins ago
Grant and Contract Administrator II
University of New Hampshire
United States
Attends regular meetings, training sessions and professional development workshops/seminars to keep current on policies and procedures relevant to position responsibilities, as requested…
Added 6 mins ago
TU
Training Department Associate (Mandarin Preferred)
TESOLIFE US INC
Flushing, NY
- $22 USD / hour
The Training Department Associate supports the Training Manager in coordinating and delivering employee onboarding, store operations training, new store opening training, and ongoing…
Added 6 mins ago
Director- HR Strategy & Operations
Pantherx Specialty LLC
Remote, United States
…establishes scalable HR processes, leads cross functional HR Programs and Projects, and ensures compliance with applicable employment laws and regulatory…
Added 7 mins ago
SPO Project Manager
Turner Construction
Pittsburgh, PA
Lead development of high-performance teams through supervision, training, coaching, and mentoring. Ensure regular feedback with staff including timely completion of performance appraisals.
Added 8 mins ago
WA
Airside Experience Specialist - Part Time
Working at Signature Aviation
East Boston, MA
- $23 USD / hour
- Part-time
Provide professional and friendly guest service while exhibiting a positive and helpful attitude to everyone at all times ensuring guests always receive an exceptional experience.
Added 8 mins ago
RP
Business Operations Manager
Rocketship Public Schools
Washington, DC
- $92,000 to $98,000 USD / year
Design and lead professional development for Operations Specialists focused on behavior management skill development.
Added 8 mins ago
CB
Senior Client Solutions Manager
Canon Business Process Services, Inc.
Remote, United States
- $155,000 USD / year
…a high-performing culture rooted in continuous improvement, professional development, and data-driven operational…
Added 9 mins ago
Restaurant General Manager - Calusso - Signature Dining
Pier Sixty Six
Fort Lauderdale, FL
The Restaurant General Manager serves as the primary leader and brand ambassador for Calusso, establishing a culture of service excellence, accountability, professionalism, and continuous…
Added 10 mins ago
Academic Support Coordinator & Executive Assistant
Winter Park, FL
Work with the Faculty Data Manager to arrange logistics (including catering and special needs) for on-campus and off-campus events related to the Office of the Dean of the College of…
Added 11 mins ago
Director, AP Marketing & Sales
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Remote, United States
The New Course Design (NCD) department leads the research, design, development, and launch of new courses and their associated exams, instructional resources, and teacher professional…
Added 11 mins ago
Director, AP Engineering
College Board
Remote, United States
The New Course Design (NCD) department leads the research, design, development, and launch of new courses and their associated exams, instructional resources, and teacher professional…
Added 13 mins ago
ONEplace@kpl Associate
Kalamazoo Public Library
Kalamazoo, MI
Supports the development, coordination, and implementation of ONEplace programs and initiatives, including the Emerging Leadership Academy.
Added 13 mins ago
NB
Senior Manager, School and Family Programs
National Building Museum
Washington, DC
- $68,000 to $70,000 USD / year
Adapt short and long-term vision for family programming into a robust schedule of programs where you will be responsible for managing you and your team's development, implementation and…
Added 14 mins ago
Professional Staff Nurse
UPMC - Pittsburgh Medical Center
Seneca, PA
Graduate Nurses that are eligible for the State Board Licensure and Professional Staff Nurses with nursing experience will be considered for this position. UPMC is proud to be a leader in…
Added 14 mins ago
TH
Full-Time Merchandiser (Hanover, PA Territory)
Turkey Hill
Conestoga, PA
- Full-time
…1931. We offer competitive pay, great benefits, and leadership development opportunities with career-growth potential – join our team…
Added 14 mins ago
SO
SPM 14
State of Michigan
Newaygo County, MI
- $32.34 to $49.02 USD / hour
Provide direct management of professional Children's Service's staff who investigate allegations of abuse and/or neglect of children and who provide supervision of children foster care…
Added 14 mins ago
SO
SAM15 - Human Services Analytics (section manager)
State of Michigan
Lansing, MI
- $47.78 to $68.73 USD / hour
This position functions as the State Administrative Manager for Agency Services supporting MDHHS - Data, Analytics, & Visualizations Division/Human Services Analytics Section within the…
Added 14 mins ago
Behavioral Health Specialist I PD
EPBH Emma Pendleton Bradley Hospital
United States
…children and adolescents in inpatient or partial psychiatric programs. Working under the Clinical Nurse Manager, Program Director, and Charge RN, the BHS I helps structure the therapeutic…
Added 15 mins ago
Medical Assistant - Ophthalmology Clinic
FMOL Health
Monroe, LA
f. Assumes personal responsibilities for continuing education and professional development.

DOCTORS HEALTHCARE PLANS, INC.

Case Manager RN

Coral Gables, FL, United States

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Job details

Posting language: English
Posted: Oct 30, 2026

Original job description

Position Purpose: Nurse Case Manager who is responsible for coordinating the continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery and compliance with medical regime.

Responsibilities:

Performs and coordinates the initial assessments and ongoing reassessments of the patient's status.
Documents patient case information within a database system.
Performs chart review/audits monthly or as needed.
Participates in monthly case conferences by providing information pertinent to patient’s needs/ goals.
Partners with the Program Director in development and review of the patient’s individualized coordination of care plan.
Ensures that the patients’ medical needs are addressed; consults with the patients’ physicians as needed, coordinating plans of treatment, and advocating for the patient when necessary.
Promotes understanding of the medical factors affecting the targeted population.
Identifies and assists patient(s) in accessing entitlements, resources, information, and referrals for psychosocial needs.
Maintains accurate and timely patient information, which is readily accessible for review and meets all requirements; assists in data collection for reporting/funding sources.
Help accomplish goals; acts as a liaison between primary care providers, specialist, and/or patient.
Advocates on behalf of patient regarding accessibility of services.
Participates in outreach activities to the entire target population, as directed.
Recommends program/service changes to meet gaps in service in the community.
Performs other duties as assigned/ necessary.
To promote member safety through a pharmaceutical management program, The CM is expected to complete medication reconciliation upon discharges of members when discharge from facilities such hospitals, long term acute centers, skilled nursing facility, and as determined by member needs.
The CM will follow up with the needs of the member when dealing with DME or HHC.
The CM will offer community support when available and pertinent to the members well-being.
Improve coordination of care by facilitating communication between members of the care team, including member, family, healthcare facility, attending physician, primary care physician, specialty, ancillary and other providers (as applicable).
Identify members considered to be high-risk for complicated, long-term, and/or continuous care in order to assure appropriate coordination of care and complex case management intervention with the primary care physician and care team; members have the opportunity to opt-in or opt-out of care management programs.
To establish and maintain clinical standards – preventive health and clinical practice guidelines.
Referral of members to internal and external programs.
Appropriate coordination of member benefits through interventions such as: Transportation Appropriate approval of ambulance usage, DME and home health care services.
Steering members toward the care of participating and preferred providers.
Assist the member with accessing Medicaid resources, when applicable.
Using professional judgement, independent analysis and critical-thinking skills applies clinical guidelines, policies, benefit plans, etc. to determine the appropriate level of care, intensity of service, length of stay and place of service.
Identifies existing problems; anticipates potential problems and acts to avoid them.
Develops plan of care based upon assessment with specific objectives, goals and interventions designed to meet member’s needs.
Identifies appropriate health care resources based on member's medical needs, including but not limited to evaluating contracts and negotiating with facilities/vendors.
Works with the member/family, provider(s), and other members of the health care team to develop a plan of care that enhances the clinical outcome while maximizing the member’s benefits.
Applies evidence-based guidelines when available.
Effectively utilizes community resources and care alternatives.
Implements and coordinates interventions and other activities that lead to the accomplishment of goals established in the case management plan.
Continually reassesses services delivered to the member to determine if the goals of the plan of care are being met, whether the goals continue to be appropriate and realistic, and what actions may be implemented to enhance positive outcomes.
Monitors information from all relevant sources about the case management plan and interventions to determine the plan’s effectiveness.
Improve coordination of patient care, reduce and remove cultural and healthcare system barriers, promote timely treatment, empower and coach patients to become self-advocates, and assist patients navigate the maze of the managed care delivery system.

Essential Job Functions:

Assist SNP Case Manager Director with MBR’s HRA outreach calls.

Be the system navigator and point of contact for patients enrolled in managed care programs, assist patients with benefit coverage and access to care questions/ concerns.
Provide enhanced care coordination services assisting patients in problem solving with issues related to the health care system, financial or social barriers (e.g. transportation as appropriate, prescription drugs formulary assistance, etc.)
Identify and link patients with cultural and community resources to facilitate referrals and respond to social services needs.
Collaborate with other services providers for care coordination and case management activities.
Work with patients over the phone to review and remind their plan of care and progress towards their care management goals.
Conduct outreach activities to assigned members by phone, mail or any other form of communication method to promote program engagement and marketing strategy Assist in data collection and report statistical information.
Performs other job duties as required by manager/ supervisor.

Qualifications:

RN or LPN Licensure required
Managed Care experience preferred
Bi-lingual English and Spanish preferred
Ability to take action in solving problems, exhibiting sound judgement
Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts
Demonstrate strong organization and time management skills

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.

No Third Party Agencies or Submissions Will Be Accepted.

Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP

Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.

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More about this job

Skills

Regulatory compliance
Provide information
Reporting
Primary care
Communication skills
Case management
Critical thinking
Patient care
Problem solving
Health care system
LPN
Time management

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