Care Management Specialist Jobs

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary – Case Manager Analyst - Field Location: Will & DuPage Counties, IL Must reside in one of the following Zip Codes: 60606, 60607, 60608, 60609, 60610, 60611, 60612, 60614, 60622, 60623, 60624, 60632, 60639, 60644, 60647, 60651, 60653 This Case Management Analyst Field position is with Aetna’s Long-Term Services & Supports (LTSS) team and is a field-based position. The requirement is for candidates to travel up to 75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meeting contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources. Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary – Case Manager Analyst - Field Location: Champaign, IL This Case Management Analyst Field position is with Aetna’s Long-Term Services & Supports (LTSS) team. The requirement is for candidates to travel 75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meeting contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources. Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case man

Become a part of our caring community The Field Care Manager Nurse 2 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. You will report to the Manager, Care Management of Behavioral Health. The Field Care Manager Nurse 2 employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. In this role, you will travel up to 50% of the time to support collaboration, conduct face-to-face meetings, and engage directly with staff, providers, members, and their families. NOTE: You should reside close to the Midlands OR Upstate area where your region will be. Use your skills to make an impact Required Qualifications Bachelor's in nursing (BSN) and have an active license in the state of South Carolina without disciplinary action. Must reside in the State of South Carolina 2 or more years of experience of case/care management 2 or more years working with the behavioral health population Knowledge of community health and social service agencies and additional community resources Use a variety of electronic information applications/software programs including electronic medical recor

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Program Overview: Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. This position is focused on assisting members in: Kankakee, Iroquois, Livingston, Ford, Champaign and surrounding counties. Position Summary/Mission: The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources. Fundamental Components • Evaluation of Members: Through the use of care management tools and information/data

Become a part of our caring community The Field Care Manager Nurse 2 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. You will report to the Manager, Care Management of Behavioral Health. The Field Care Manager Nurse 2 employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. In this role, you will travel up to 50% of the time to support collaboration, conduct face-to-face meetings, and engage directly with staff, providers, members, and their families. Note: travel requirements have shifted and you will only need to travel up to 50%. Also, one of the questions within the application relate to travel and can't be adjusted to reflect the change. NOTE: You should reside in the Midlands OR Upstate area where your region will be. Use your skills to make an impact Required Qualifications Bachelor's in nursing (BSN) and have an active license in the state of South Carolina without disciplinary action. Must reside in the State of South Carolina 2 or more years of experience of case/care management 2 or more years working with the behavioral hea

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Schedule: Monday-Friday 8AM - 5PM Travel: Up to 55-75% travel in and around Yale New Haven, CT. Position Summary Program Overview Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Family Summary/Mission Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies, and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strateg

Become a part of our caring community The Transition Coordinator (Care Coach 2) evaluates member's needs and requirements. This evaluation aims to achieve and/or maintain an optimal wellness state. The Coordinator does this by guiding members/families toward resources and facilitating interaction with them. These resources are appropriate for the care and wellbeing of members. The Care Coach 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Position Responsibilities: Support the ongoing member transitions in and out of the Indiana Medicaid programs, the Contractor's enrollment, and among care settings. Complete transitions and assists with the planning and preparation for them, and the follow-up care after. Works with the Member Advocate Coordinator and other member-focused departments of the plan. This collaboration ensures continuity and coordination of care and member and provider communication through the initial transition, ongoing benefit plan, and MCE transfers. Ensure the transfer and receipt of all outstanding prior authorization decisions, utilization management data, and clinical information such as prevention and wellness programs(s), care management and complex case management notes. Help with transitions from the custodial setting to the home and community-based setting. We ask that you have telephonic and in-person meetings within an assigned region. The purpose of these meetings is to work with various stakeholders, including long-term care members, hospital/rehab staff discharge planners, family members/POA's, PCP's, and other healthcare professionals. The ultimate goal is to prevent custodial placements whenever possible. Assess and evaluate member's needs to establish a member specific car

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Requisition Job Description Program Overview: Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Position Summary The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources Required Qualifications • Must reside in the state of Illinois •Must possess reliable transportation and be willing and able to travel up to 50-75% of the tim

Become a part of our caring community The Medical Director, National Outpatient Medicare leverages clinical expertise and medical judgment to review preauthorization requests for services. This role is responsible for evaluating moderately complex to complex cases, where analysis of clinical information and situational factors requires in-depth assessment and sound decision-making. As a Medical Director at Humana , you will use your clinical expertise and judgment to make meaningful coverage and care determinations that support quality, consistency, and compliance across the healthcare continuum. In this role, you will review requests for services, level of care, and site of service, using nationally recognized clinical guidelines, CMS policies, medical references, and internal clinical resources to guide decision-making. This position offers the opportunity to work on complex outpatient cases , review clinical documentation, and collaborate with both internal partners and external physicians to gather additional information and discuss determinations. You may also contribute to care management activities and, depending on the role, provide input on areas such as clinical documentation, coding, grievances and appeals, and outpatient services or equipment reviews. Beyond case review, this role provides the opportunity to build strong relationships with physicians, provider groups, facilities, and community partners in support of regional priorities. It is a strong fit for physicians who are interested in contributing to value-based care, population health, and care management strategies while working in a structured environment that values sound clinical judgment, collaboration, and operational excellence. Humana is seeking a Medical Director to

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: Accountable for Commercial, Medicare, Exchange and Medicaid NCQA Accreditation quality projects and initiatives through design, development, and implementation. This role focuses primarily on Delegated Credentialling and Oversight of the delegated Credentialling organizations, per contract. Proactively builds strong business relationships with internal and external business partners. Participates in presentation to business partners on accreditation requirements to achieve results and ensure accreditation readiness. Proven experience as a subject matter expert on NCQA accreditation standards, analysis, Delegated Credentialing file reviews and supporting quality functions. Primary Job Duties & Responsibilities: Utilizes statistical analysis, data visualization tools, and database queries to identify trends, patterns, and opportunities for quality improvement. Develops and maintains performance metrics and dashboards to track and report on patient safety, clinical effectiveness, patient experience, and compliance with quality standards. Contributes to quality improvement projects and initiatives by providing data-driven insights and recommendations. Collaborates with cross-functional teams to design and implement evidence-based practices, care protocols, and process improvements. Assists in conducting audits and performing chart review

Our mission and customers: We are creating the freedom for SMEs to succeed by delivering Europe's leading finance workspace with banking at its core, augmented by financial tools. We are proud to be rated 4.8 on Trustpilot, based on 55,000+ reviews. Our culture puts customer satisfaction at the core of what we do, as proven by our Net Promoter Score of 75 (more about our culture here). Our journey: Founded in 2017 by Alexandre and Steve, Qonto has grown to 1,600+ Qontoers serving over 600,000+ customers across 8 European countries. We have been profitable since 2023, and we are just getting started. Our beliefs: We hire for skills and potential. With 80+ nationalities, 45% women, of which 56% of women in our leadership team, diversity isn't a program; It's who we are. We've built a discrimination-free hiring process because the best teams are built on merit. AI at Qonto: AI is deeply embedded in how we work (here) - Every Qontoer gets unlimited access to the best AI tools. We want people who experiment without waiting for permission, push AI beyond the obvious, know when to trust it, and when to question it. ------------------------------------------------------------------------------------------------------ Join us as Customer Care Manager in the Account Management team to give our French market clients the kind of support that makes them feel genuinely taken care of. You'll resolve production tickets, untangle complex problems, and help shape the way our Account Management team operates, under the guidance of Axelle, our Team Lead. ➡️ What you'll do Own client tickets end-to-end: Solve problems across chat, email, and occasional video calls for non-VIP clients in the French market. Dig into the details: Investigate account activity, company profiles, and transaction history to find the right answer, not just a quick one. Go beyond the obvious fix: Proactively recommend products or solutions based on what each client actually needs. Partner with Product and Tech

Location: United States – Remote Clearance: Ability to obtain and maintain a Public Trust Salary Range: 110K - 120K LTS is seeking a Program Manager to support the Department of Veterans Affairs (VA) Health Portfolio. The Health PMO support contract provides IT program management, project management, technical management, financial management, functional planning, and documentation analysis in support of the Enterprise Program Management Office (EPMO) Enterprise Program Management Division (EPMD) Health Portfolio The VA Health Portfolio is focused on development and execution of quality IT projects that address the needs of Veterans and health care providers through management of health care information and sustainment of production software to keep the mission going. What you'll do: Oversee and be responsible for all aspects of a fast-pacing project serving as direct interface with the client, managing project schedules, milestones, deliverables and budget in accordance with Federal, VA standards and guidelines. Ensure quality customer service, provide guidance on technical solutions, and maintain a good working relationship with all customer staff, in support of the program. Prepare for and conduct meetings, presentations and briefings related to all phases of the product lifecycle, while ensuring program goals of the VA and TISTA are met. Manage complex project-related issues and the implementation of solutions that involve the architecture and design, schedule, technology, methodology, tools, human centered design, components and change management including client walk-throughs, user acceptance testing and required documentation. Provide applications business and systems analysis, support long and short-range plans for product selection, requirements analysis, systems development, maintenance and operations following the systems lifecycle including production releases. Participating in PI Planning activities to ensure product and business owner requirements are

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Utilization Management Nurse Consultant (RN) – Concurrent Review Remote | Acute Inpatient Utilization Management | RN Opportunity Are you an experienced RN with a background in acute care and utilization management? Join our team and play a vital role in ensuring members receive appropriate, high-quality, and cost-effective inpatient care through concurrent review and care coordination. What You'll Do Perform concurrent reviews for acute inpatient admissions and continued hospital stays Evaluate medical necessity, severity of illness, intensity of service, and level of care using evidence-based clinical criteria Collaborate with hospitals, physicians, care managers, and discharge planners to support appropriate treatment and timely transitions of care Review clinical documentation and apply health plan benefits and regulatory requirements to authorization decisions Partner with Medical Directors on complex cases and escalations Facilitate discharge planning and identify opportunities to optimize care and resource utilization Manage a high-volume caseload while meeting quality, productivity, and turnaround-time standards WHAT YOU BRING - REQUIRED Active, unrestricted RN license in your state of residence Ability to obtain and maintain additional state licensure as required 5&#43

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Company: Oak Street Health Title: Manager, Care Program Strategy & Operations (Vaccine) Location: Remote/Virtual Role Description: The Manager, Care Program Strategy & Operations (Vaccine) plays a critical role within Oak Street Health’s Population Health organization, supporting the design, implementation, and scaling of programs that improve patient health outcomes and advance value-based care objectives. This role focuses on vaccine strategy and execution, driving initiatives that improve immunization rates, close care gaps, and support preventative care delivery across the organization. Serving as a key cross-functional leader, this individual partners closely with Population Health, Clinical Operations, Nursing, Providers, Patient Safety, Epic, and external healthcare partners to develop and implement innovative solutions that improve patient outcomes and operational performance. The role requires strong project management capabilities, stakeholder influence, and the ability to execute complex initiatives across multiple teams and partners. This is a highly visible role responsible for bringing new ideas from concept to execution, including the development of pilot programs, evaluation of results, and scaling of successful interventions across Oak Street Health centers nationwide. The Manager will also support strategic partnerships an

Work Flexibility: Field-based Emergency Care (Fire/EMS) Sales Representative As a Sales Representative at Stryker, you will be at the forefront of promoting and selling our Emergency Care products, with a focus on Fire Emergency Medical Services solutions, to pre-hospital providers. You’ll work with a diverse range of products, including Emergency Patient Transport, Defibrillators, Automated External Defibrillators (AED), and Chest Compression systems. This role will involve building and maintaining strong customer relationships, addressing inquiries, negotiating pricing, and managing orders seamlessly. By staying informed on industry trends, competitor activity, and regulatory shifts, you’ll position Stryker’s products effectively in the marketplace. You’ll also have the opportunity to exceed sales targets, monitor your performance, and collaborate with marketing and support teams to drive business growth and success. What you will do Continue experience in sales or clinical setting. Promote and sell Stryker Emergency Care products to meet our customers’ needs. Achieve your assigned quota by taking a consultative approach to Pre-Hospital sales, marketing, clinical and demonstrations of all related Fire/Emergency Medical Services products and programs. Become the resident Emergency Care expert as you work with a sophisticated audience of fire chiefs, medical directors, clinical instructors and administrators. Your knowledge not only of your own products, but of competitors’ offerings, builds credibility with your customers. <span style="f