Working in partnership with the members primary care provider and interdisciplinary team, the community-based provider is responsible for seeing members recently discharged from the hospital and ensuring a smooth transition of care to prevent readmissions, seeing members who have urgent clinical needs and addressing them so they can avoid a trip to the Emergency Room, and performing chronic disease management and preventive care in conjunction with the center-based primary care team. Job DescriptionJob Summary
The Community Based Advanced Practice Provider focuses on providing both urgent and primary care to our members where they live.
Working in partnership with the member’s primary care provider and interdisciplinary team, the community-based provider is responsible for seeing members recently discharged from the hospital and ensuring a smooth transition of care to prevent readmissions, seeing members who have urgent clinical needs and addressing them so they can avoid a trip to the Emergency Room, and performing chronic disease management and preventive care in conjunction with the center-based primary care team. Coordinate with care team, patient/member, family, and caregivers to help resolve barriers to care and transition back to Medical Center setting.
strong>Licenses and Certifications- SLP - Speech Language Practitioner License to practice Speech-Language Pathology in the State of Maryland or Virginia or Certificate of Competency by ASHA (American Speech-Language-Hearing Association) if working in the District of Columbia Maryland or any combination as required based on work location(s) Upon Hire required and.
- Provides patient and/or caregiver education regarding the injury/disease process functional limitations and the purpose of treatment interventions in addition to training in aspects of care the patient/caregiver will need to manage after discharge.
p>System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. Collaborate closely with recruiting and delivery teams to ensure strong execution and client satisfaction.
Randallstown, MD14 days ago
Assists nurse Care Managers in communicating with the patient denied hospital days as well as the issuance of Medicare forms including HINN, Detailed Notice of Discharge to patients/family/significant other when they are in disagreement with the discharge plan arranged by attending and Care Management personnel.
p>We’re looking for a senior-level sourcing/procurement professional who can independently run end-to-end strategic sourcing events—from intake through award and contract execution—for professional services and/or IT categories in a complex, regulated environment. This is a highly stakeholder-facing role that requires confidence operating when requirements are still forming, strong contract redlining/negotiation skills, and comfort partnering closely with Legal and Risk.
College Park, MD27 days ago
The Clinical Dietitian is responsible for collecting pertinent information development of appropriate care plans monitoring the status of patients counseling patient and family on special nutritional requirements consulting with other health personnel (physician nurse pharmacist case manger therapist etc.) as appropriate. Provides patient with ongoing nutrition assessment and outcome-oriented nutrition counseling necessary to assist patient in achieving and sustaining an effective nutritional status.
System One, and its subsidiaries including Joulé, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. As our Supply Chain Manager, you’ll own and continuously improve all aspects of materials management and inventory control, including sourcing, planning, logistics, and supplier performance.
Silver Spring, MD2 days ago
See Sunrise Senior Living Terms & Conditions at https://c-5885-20221207-www-sunriseseniorliving-com.i.icims.com/terms-and-conditions and Privacy Policy at https://c-5885-20221207-www-sunriseseniorliving-com.i.icims.com/privacy-policy and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. The unique responsibilities for this role include but are not limited to the essential functions listed as follows: Coordination of Health Needs:- Identify on-going needs and services of residents in promotion of the highest quality resident services to be delivered.
Join us in this journey of care, compassion, and leadership as we work together to make a difference where it matters most, serving as a key member of our leadership team overseeing the day-to-day operations and management of our Case Management department. - Oversee the interdisciplinary plan of care and the discharge planning process to ensure the effectiveness and appropriateness of services with a central focus on census management, patient care outcomes, and key care indicators.
p/>Join the fun and follow us on social media to see what's happening at our company, and don't forget to connect with us on Lennar: Overview | LinkedIn<https://www.linkedin.com/company/lennar/> for the latest job opportunities.
Lennar is one of the nation's leading homebuilders, dedicated to making an impact and creating an extraordinary experience for their Homeowners, Communities, and Associates by building quality homes and providing exceptional customer service, giving back to the communities in which we work and live in, and fostering a culture of opportunity and growth for our Associates throughout their career.
Baltimore, Maryland30+ days ago
li>Attributed beneficiaries receive a follow up interaction from the TOC Care manager coordinator within 2 business days for hospital discharge and within one week for Emergency Department (ED) discharges; Coordinates referral management for attributed beneficiaries seeking care from high-volume and/or high-cost specialists as well as EDs and hospitals; Facilitates connection to services for patients who may benefit from behavioral health services including: patients with serious mental illness patients with substance use disorders' patients with depression anxiety or other mental health conditions patients with behavioral and social risk factors and BH issues patients with multiple co-morbidities and BH issues; elevates patients requiring longitudinal / ongoing care management needs following discharge to the CTO Lead Care manager MDPCP Social needs teams and or MDPCP Amb pharmacist where appropriate. In collaboration with the interdisciplinary care team acts as primary care team agent for the episodic care needs and coordination of care for a panel of attributed Medicare beneficiaries following discharge by ensuring the following: Ensures attributed beneficiaries have timely access to care (same day or next day access to the patient's own practitioner and/or care team for urgent care or transition management); Assists patients with scheduling appointments with providers including annual wellness visits.
Baltimore, MD30+ days ago
As a Care Manager Social Work, you will serve as a member of the interdisciplinary care management team capable of furnishing an array of care coordination services to Medicare FFS beneficiaries attributed to practices that the Care Transformation Organization (CTO) supports. Communicates effectively while performing telephonic interviewing and communication with external contacts and while interacting with Case Management Specialists, Management Team, Physicians, and other interdepartmental contacts.
li>Work with all clinical teams as a resource on care management of assigned patients of the practice to include: pre-visit planning workflow to ensure care completion prior to visit whenever possible, after visit summary review with patients whenever appropriate, patient engagement to involve the patients in activities to improve their health, and patient education about self-management tasks they can undertake to gain greater control of their health status. The Nurse Care Manager develops and maintains collaborative working relationships with all team members including Practice Manager, Lead Physician, and Care Coordinator, and Behavioral Health Care Manager to best serve the needs of the identified patient panel and primary care teams.
li>Perform regular check-ins guided by the TOC program, including post-discharge home visits and weekly follow-ups for four weeks, ensuring provider visits are completed and addressing member needs promptly.
You must complete Cityblock’s medical clearance requirements, which include, but may not be limited to, evidence of immunity to MMR, Hepatitis B, Varicella, and a TB screen, or have an approved medical or religious accommodation that precludes you from being vaccinated against these diseases.
li>Perform regular check-ins guided by the TOC program, including post-discharge home visits and weekly follow-ups for four weeks, ensuring provider visits are completed and addressing member needs promptly.
You must complete Cityblock’s medical clearance requirements, which include, but may not be limited to, evidence of immunity to MMR, Hepatitis B, Varicella, and a TB screen, or have an approved medical or religious accommodation that precludes you from being vaccinated against these diseases.
Baltimore, MD30+ days ago
Provides Complex Case Management, including chronic disease case management, critical diagnosis care coordination, transition care management, high risk clinical tracking, complex medication management and system utilization to appropriate patients. JOB SUMMARY: The Nurse Care Manager provides professional, patient centered nursing care in the ambulatory setting in accordance with the multi-disciplinary plan of care and established policies and procedures, under the supervision of the Lead Nurse.
The Care Manager partners closely with members and the interdisciplinary care team to develop and implement person-centered plans of care that promote a positive member experience, improved health outcomes, and cost-effective service delivery. The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Based on this assessment, and in conjunction with the patient, patient's nephrologist & PCP, and other members of the care team, create and implement a care plan that will address identified needs, remove barriers to care, and improve the health of the patient; Coordinate care by serving as the advocate and resource for the patient, their family, and their provider(s); Facilitate care across the continuum of care, spanning settings such as the home, hospital, skilled nursing facility, and acute care facility; Manage patients during periods of transitions of care to facilitate effective transitions and minimize avoidable readmissions; Assess the patient's knowledge of their renal condition and provide education and self-management support; Provide ongoing reassessment and follow-up to improve patient outcomes. The primary focus will be to improve patient outcomes by helping patients get permanent access, promoting home dialysis modalities & kidney transplantation, educating patients on self-management, addressing risks associated with comorbid conditions, and coordinating their care.
The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes. Federal Disclosure Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
He/ she works collaboratively with physicians and other members of the health care team to achieve the highest quality clinical outcomes with the most cost-effective use of available resources. Identifies potential areas of compliance vulnerability and risk; develops and implements corrective action plans for resolution of problematic issues; and provides general guidance on how to avoid or deal with similar situations in the future.
Care Manager, RN University of Maryland Baltimore Washington Medical Center
Care Manager, RNTowson, MD30+ days ago
Required) • 2 - 4 years Acute Case management, discharge planning or utilization management Required Skills: • Strong Verbal Communications Skills • Strong Written Communications Skills • Excellent Interpersonal Skills • Medical Terminology. UM St. Joseph has been recognized by The Leapfrog Group as a grade 'A' hospital and by U.S. News & World Report as #3 in both the state and Baltimore Metro area, making UM St. Joseph the highest-ranking community hospital in Maryland.
The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes. Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health Utilization Review, Disease Management, or other direct patient care experience.
Baltimore, MD30+ days ago
As a Care Manager Social Work, you will serve as a member of the interdisciplinary care management team capable of furnishing an array of care coordination services to Medicare FFS beneficiaries attributed to practices that the Care Transformation Organization (CTO) supports. Communicates effectively while performing telephonic interviewing and communication with external contacts and while interacting with Case Management Specialists, Management Team, Physicians, and other interdepartmental contacts.
p>Under general supervision, provides psycho-social services including: psychosocial assessment, complex discharge planning, coordination of services, resource referral, support group facilitation and consultation. Skills:
- Knowledge of various social, home care, extended care, hospice, government program, commercial insurance and community services.
li>Attributed beneficiaries receive a follow up interaction from the practice within 2 days for hospital discharge and within one week for Emergency Department (ED) discharges; Coordinates referral management for attributed beneficiaries seeking care from high-volume and/or high-cost specialists as well as EDs and hospitals; Facilitates connection to services for patients who may benefit from behavioral health services including: patients with serious mental illness patients with substance use disorders' patients with depression anxiety or other mental health conditions patients with behavioral and social risk factors and BH issues patients with multiple co-morbidities and BH issues; Assists with identifying patients to participate in the Patient-Family/ Caregiver Advisory Council (PFAC) and help to organize and facilitate the PFAC annual meetings; Engages attributed beneficiaries and caregivers in a collaborative process for advance care planning (MOLST Advanced Directives Proxy). In collaboration with the interdisciplinary care team acts as primary care team agent for the coordination of care for a panel of attributed Medicare beneficiaries by ensuring the following: Ensures attributed beneficiaries have timely access to care (same day or next day access to the patient's own practitioner and/or care team for urgent care or transition management); Facilitates use of alternatives for care outside of the traditional office visit to increase access to the care team and the practitioner such as e-visits phone visits group visits home visits and visits in alternate locations (senior centers assisted living) captured in the medical record; Assists patients with scheduling appointments with providers including annual wellness visits.
Silver Spring, MD6 days ago
div style="text-align:justify"> Role Overview: The RN Case Manager (Inpatient Care Coordinator - ICC) plays a crucial role within the interdisciplinary team, overseeing patient care from admission to transfer or discharge. Discharge Planning Leadership: Lead the team in creating complex discharge plans that balance cost-effective hospital resource use with minimized patient expenses.
Baltimore, MD30+ days ago
RN Applicants: Current registered nurse licensure in the State of Maryland AND CPR/BLS certification Social Work Applicants: Licensure by the Maryland Board of Social Work Examiners at LMSW level Exceptions: Is licensed to practice social work in another state or possesses social work qualifications in another jurisdiction comparable and Meets requirements established by the Board in regulations and Has an application for a license pending before the Board orHas successfully passed an examination or examinations prescribed by the Board pertinent to the license sought. RN Applicants: 1 year of full-time (or equivalent) Case Management experience OR three years full-time nursing experience, preferably in acute care setting; SW Applicants: 1 year of experience in providing clinical social work service or care coordination preferably in a mental health/health care setting (internship may apply), or Case/Care Management role.
Baltimore, MD30+ days ago
Trustworthy Staffing Solutions has proudly served the community for 20 years, delivering high-quality healthcare staffing and home care services. We are seeking a compassionate and experienced Registered Nurse (RN) to join our growing home care team as a Case Manager.
p>The Maryland Primary Care Program (MDPCP AHEAD) RN Care Coordinator will work closely with Primary Care providers in the state of Maryland to identify, screen, track, monitor, and coordinate the care of patients with multiple chronic conditions to develop and deliver Comprehensive Primary Care to patients. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Silver Spring, Maryland30+ days ago
div>Aging Well Eldercare, a well-established Aging Life Care Management practice serving the D.C. and the Maryland suburbs for over 37 years, is seeking an RN to join our highly supportive and collaborative team.
. Their guidance leads families to the actions and decisions that ensure quality care and an optimal life for those they love, thus reducing worry, stress and time off of work for family caregivers through:
- Assessment and monitoring.
Baltimore, MD30+ days ago
Provide complex case management, including chronic disease case management, critical diagnosis care coordination, transition care management, high-risk clinical tracking, complex medication management, and system utilization support. The Nurse Care Manager works in a multidisciplinary clinical setting with exposure to multiple specialties and a broad range of patient needs, including uninsured and low-income populations.