CL
Manager overseeing medical review processes for Medicare claims at BlueCross BlueShield of South Carolina. Ensuring compliance with standards and laws while driving continuous improvement in claim processing.
About the role
- Part-time RN Care Manager supporting elders and adults with disabilities at Lakeland Care, coordinating services and promoting wellness. Covering multiple service regions and collaborating with interdisciplinary teams.
Responsibilities
- Conduct a comprehensive assessment of the member's outcomes, needs and risks; and reassesses as the member’s outcomes and/or condition changes
- Monitor, and evaluate members’ outcome-based member-centered plans, considering cost and effectiveness in authorizing services and choosing providers
- Participate in home visits and care conferences involving the member, their supports and providers to assess, reassess, and address health and medically related needs
- Coordinate acute and primary care services, care transitions and related follow-up care
- Promote prevention, wellness, and chronic condition management by incorporating preventative, supportive, restorative, and rehabilitative care into the care planning process
- Implement risk mitigation strategies to promote the member’s health, safety and independence while respecting the member’s rights
- Create and maintain member records as required by the Department of Health Services (DHS) contract and LCI policy
Requirements
- Current License to practice as a Registered Nurse in the State of Wisconsin
- Bachelor’s degree in nursing strongly preferred
- Two (2) or more years of skilled nursing experience preferred, ideally in gerontology/disabilities and/or home care
- Demonstrates proficiency in applying the Family Care principles and Resource Allocation Decision process to practice
- Ability to be adaptable, prioritize and work in a fast-paced environment
- Working knowledge of computers, computer programs, typing, and data entry
- Ability to access members’ homes which are not required to comply with the ADA regulations
- Ability to lift up to 25lbs
- Current driver’s license, acceptable driving record and proof of adequate insurance
Benefits
- Strong time management skills to manage workload and caseload logistics
- Ability to establish relationships across LCI with the assigned CM Supervisor, team and their support divisions during times of coverage
- Participate in on-going training as required; maintain current knowledge to ensure compliance with Federal and State regulations, LCI policy and procedure and accepted professional standards
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
Restaurant Leader Trainee responsible for managing restaurant operations and leading team at 7 - Eleven. Focusing on customer service, training, and business compliance in a fast - paced environment.
Quality Systems Manager overseeing quality systems, compliance and food safety initiatives at McCormick's plant. Managing HACCP and quality assurance programs in a food manufacturing environment.
Quality Systems Manager overseeing the development and implementation of Quality Systems at McCormick. Ensuring compliance with regulations and managing sanitation and HACCP requirements in food manufacturing.
BC
Manager overseeing medical claim reviews ensuring compliance with standards and implementing process improvements. Engaging with regulatory bodies and maintaining quality performance standards in healthcare.
RN Navigator Case Manager performing case management in Miami, Florida with emphasis on improving care coordination. Engaging members and providers for optimal health outcomes while ensuring adherence to medical necessity guidelines.
Store Manager leading a team who serve with heart at Asda Express locations. Driving sales, exceptional customer experience, and maintaining store performance and compliance.
Manager Trainee learning to manage operations and compliance in supply chain logistics. Responsible for driver relations, fleet productivity, and administrative tasks.
Relief Camp Manager responsible for efficient operation and housekeeping of LandSea camp facilities in Alberta. Overseeing staff, safety, and client satisfaction.
Assistant Process Manager responsible for scheduling and managing seed production operations in Buzet - sur - Baïse, France. Collaborating with teams and overseeing machine operations and team training.