5 Care Management Jobs

As an Anesthesiologist, your primary responsibility will be to administer general and regional anesthesia to patients. You will be required to perform cardiopulmonary resuscitation (CPR) in emergency situations when a patient needs life-saving care. Gathering data from patients, medical charts, and collaborating with the medical care team will also be part of your duties. Monitoring patients" vital signs such as blood pressure, body temperature, heart rate, and respiration rate before and during procedures is crucial. You will be managing the care patients receive before and after anesthesia administration. Coordination with other healthcare team members to provide ventilator support and pain management post-procedure is essential. Additionally, you will be responsible for checking and maintaining patient records, ensuring they are updated accurately. This role is a full-time position and offers benefits including health insurance, leave encashment, paid sick time, and provident fund. The work schedule may involve day shifts and rotational shifts. An added perk includes a yearly bonus based on performance. If you are a dedicated Anesthesiologist with a passion for patient care and a commitment to ensuring safe anesthesia administration, we welcome you to apply for this rewarding opportunity.,

Visionet is looking for a passionate and experienced Senior Consultant to create and support innovative solutions for healthcare providers and health services. This role offers the opportunity to focus on transforming care coordination, enhancing digital engagement, and enabling population health management through technology. As a core member of the HLS Industry Solutions Team, you will be instrumental in translating provider workflows and data into effective tech-enabled offerings, contributing to the growth of our healthcare practice. We are seeking a highly motivated and collaborative individual with broad exposure across the provider solutions sector and deep expertise in 1-2 core areas such as patient/member engagement and care management. The ideal candidate should be enthusiastic about enhancing healthcare delivery and keen on: - Designing and implementing solutions to enhance care coordination and patient outcomes. - Utilizing cutting-edge technologies to address critical challenges in the healthcare industry. - Growing expertise in a fast-paced, innovative environment and making a tangible impact for our clients. Key Requirements For Success: - 6-10 years of experience in a US healthcare provider or integrated health system context, preferably in a consulting or operations role. - Additional experience in serving the UK/EU market would be advantageous. - Proficiency in areas such as patient/member engagement strategies, care management or care coordination programs, and population health initiatives. - Strong understanding of EHR workflows, data models, and integration touchpoints. - Familiarity with platforms and standards like Salesforce Health Cloud, EHR ecosystems (Epic, Cerner), FHIR/HL7, and data interoperability frameworks. - Excellent articulation and presentation skills to communicate complex ideas effectively to diverse client audiences. - Experience working with US and/or EU clients, including an understanding of cultural nuances and business practices. - High learning agility and adaptability to grasp new concepts quickly and apply them across different provider settings. - Proven experience with key industry platforms, data sets, and standards. - A consulting mindset with the ability to structure problems, apply frameworks, develop logical recommendations, and work independently or collaboratively.,

The Coordinator of Quality and Care Management Services at LeConte Medical Center plays a vital role in integrating financial, clinical, and quality functions under the supervision of the Manager of Quality and Care Management. This position serves as a leader, innovator, and change agent in ensuring seamless care for patients across the continuum. By collaborating with the manager, nurse manager, and other healthcare professionals, the Coordinator promotes patient care continuity and quality through evidence-based practices and quality improvement initiatives. The primary focus is on identifying and implementing best practices using a multidisciplinary approach to enhance outcomes. Key responsibilities of the Coordinator include coordinating activities within the Quality and Care Management Department, managing the department in the absence of the Manager, and serving as a unit care manager when necessary. The role involves various tasks such as performance improvement, clinical resource management, resource utilization management, care management, staff development, and general duties to ensure the efficient delivery of quality care services. The Coordinator is expected to be well-versed in performance improvement principles, analyze data to identify areas for enhancement, collaborate with healthcare team members to implement evidence-based care, and monitor Core Measures and other department metrics. Additionally, the role involves serving as a resource for Care Managers in monitoring Medicare patients, staying abreast of regulatory requirements, educating staff and physicians on compliance issues, preparing reports, and participating in Quality Improvement initiatives. To qualify for this position, candidates must possess a current Tennessee RN License and have at least three years of experience in case management with a strong understanding of quality and care management principles. While certifications in Case Management (CCM), Certification in Quality (CPHQ), or Case Management (ACMA) are preferred, they are not mandatory. The ideal candidate should demonstrate leadership skills, a proactive approach to problem-solving, and a commitment to continuous improvement in patient care delivery. Join LeConte Medical Center's team as the Coordinator of Quality and Care Management Services to contribute to the enhancement of patient care quality and continuity across the continuum.,

Role & responsibilities Come join our team! Help us tackle the data usability challenge for payers. Your expertise and experience will help drive meaningful performance outcomes. You'll also have the chance to advance your career, acquire new skills, and collaborate with some of the most innovative minds in payer data management. We are seeking an experienced Business Analyst with Utilization Management and Care Management subject matter expertise to join our growing team. You will act as a liaison between business stakeholders, the data modeling team, and technical teams, ensuring client needs and business requirements are translated into actionable technical specifications resulting in seamless data exchange and efficient data integration between formats and systems. You will contribute expertise and experience in both analytic and operational components of utilization management and care management. Within utilization management, your experience in payer-focused utilization review processes in clinical and/or pharmacy context, including prior authorization, concurrent review, appeals/denials, regulatory compliance, and with data analysis will help shape the product. Within care management, deep understanding of care management operations and plans, program evaluation, data analysis and interpretation (claims, authorizations, case management,, and member engagement will also help shape the product. Finally, demonstrated expertise in data mapping and transformation and technical requirements gathering and analysis will help optimize client implementations and develop client-facing solutions that drive business value for payers in critical programs surrounding utilization and care management, including the interplay between this area and Value Based Care, Population Health, CMS Interoperability, and Quality. You Will Be Responsible for: Requirements Gathering and Analysis . Define, analyze, and document detailed functional and technical requirements for specific data solutions. Tasks may include collecting requirements from internal SMEs, partnering closely with Client Delivery and/or Customers to gather and refine technical and business requirements, developing and reviewing QA/user acceptance testing criteria, and business systems analysis, including data and gap analyses. Stakeholder coordination/collaboration : Be a knowledgeable bridge between clients, product management, data modeling, SMEs, and other team members to define, document and share detailed functional and technical requirements and expected impact using all of the tool in your technical BA toolkit. Mock-ups/Prototyping : Create mocks-ups, sample reports, and/or output tables to help visualize and communicate requirements, workflows, and expected results, based on client problems to be solved, business rules, and technical requirements. User Acceptance Testing/QA Process . Collaborate with key stakeholders to define user stories, test cases, QA/User acceptance testing criteria for data solutions. Partnering with Agile Scrum Teams : Participate in relevant agile ceremonies, build user stories according to requirements, and help define test cases and acceptance criteria. Solution Maintenance . Co-own maintenance and create of artifacts that includes but is not limited to document portal/repository, workflows/diagrams, data mapping and technical requirements documents, analytics/business logic, user stories, and UAT scenarios and test cases. Continual Learning . Keep up to date on latest industry trends in how payers are using data to drive improvement in outcomes. Leverage this expertise to continue to refine how solutions are developed and refined to maximize value for clients. Must-Have Qualifications: Deep understanding of how US Health Insurers (payers) utilization management and care management programs clinical and pharmacy, including prior authorization processes, workflows, regulatory compliance, data analysis and interpretation (claims, authorizations, case management), and member engagement 5+ years of experience working with US healthcare data (claims, clinical, member, provider, CMS files, etc.) and standards (e.g., HL7, FHIR, EDI, CDA) and integration 5+ years of progressive experience in business requirements management (definition, documentation, mock-ups, data analysis) 3+ years experience participating in UAT process management – test case planning and scenarios, writing UAT acceptance criteria, UAT test case execution, tracking and resolving defects, and UAT closure Proficiency in data mapping and data exchange protocols (e.g., API, JSON, XML) related to health information systems. Proficiency in SQL, Python, and/or other programming languages for data extraction and transformation. Working knowledge of UM and Care Management systems of record Strong communicator who can share domain expertise effectively across multiple departments from Sales, Client Delivery, Product, Engineering, and Information Security "Roll up your sleeves mentality" working side-by-side with your team. Self-starter with demonstrated ability to drive workstreams independently and manage risks with strong compass on when to escalate issues. Demonstrated ability to thrive in a fast-paced, dynamic startup environment. Nice-to-Have Qualifications: Working knowledge of US healthcare (one or more) - health insurance markets, government sponsored health plans (Medicare/Medicaid), and/or care delivery and reimbursement models (e.g. VBC, population health, risk adjustment) Familiarity with cloud platforms (e.g., AWS, Azure, Databricks, Snowflake, etc.) for hosting healthcare applications and data storage. Experience with EHRs and/or HIEs and healthcare data workflows. Experience with healthcare analytics and data visualization tools (e.g., Power BI, Tableau) Experience with Agile methodologies in healthcare technology projects. Interest in Advanced Analytics, Data Science, and/or GenAi Preferred candidate profile

Job Description: Solicit, review and analyze business requirements Write business and technical requirements Communicate and validate requirements with stakeholders Validate solution meets business needs Work with application users to develop test scripts and facilitate testing to validate application functionality and configuration Participate in organizational projects and/or manage small/medium projects related to assigned applications Translates customer needs into quality system solutions and ensures effective operational outcomes Focus on business value proposition*Apply understanding of 'As Is' and 'To Be' processes to develop solution Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). Role Focus Areas: Core Expertise Required: Provider Management Utilization Management Care Management Domain Knowledge: Value-Based Care Clinical & Care Management Familiarity with Medical Terminology Experience with EMR (Electronic Medical Records) and Claims Processing Technical/Clinical Understanding: Admission & Discharge Processes CPT Codes, Procedure Codes, Diagnosis Codes Job Qualification: Undergraduate degree or equivalent experience. Minimum 5 Years experience in Business Analysis in healthcare including providing overall support, maintenance, configuration, troubleshooting, system upgrades, and more for Healthcare Applications. Good experience on EMR / RCM systems Demonstrated success in running EMR / RCM / UM, CM and DM systems support in requirements, UAT, deployment supports Experience working with stakeholders, gathering requirements, and taking action based on their business needs Proven ability to work independently without direct supervision Proven ability to effectively manage time and competing priorities Proven ability to work with cross-functional teams Core AI Understanding AI/ML Fundamentals: Understanding of supervised, unsupervised, and reinforcement learning. Model Lifecycle Awareness: Familiarity with model training, evaluation, deployment, and monitoring. Data Literacy: Ability to interpret data, understand data quality issues, and collaborate with data scientists. AI Product Strategy AI Use Case Identification: Ability to identify and validate AI opportunities aligned with business goals. Feasibility Assessment: Understanding of whats technically possible with current AI capabilities. AI/ML Roadmapping: Planning features and releases that depend on model development cycles. Collaboration with Technical Teams Cross-functional Communication: Ability to translate business needs into technical requirements and vice versa. Experimentation & A/B Testing: Understanding of how to run and interpret experiments involving AI models. MLOps Awareness: Familiarity with CI/CD for ML, model versioning, and monitoring tools. AI Tools & Platforms Prompt Engineering (for LLMs): Crafting effective prompts for tools like ChatGPT, Copilot, or Claude. Responsible AI & Ethics Bias & Fairness: Understanding of how bias can enter models and how to mitigate it. Explainability: Familiarity with tools like SHAP, LIME, or model cards. Regulatory Awareness: Knowledge of AI-related compliance (e.g., HIPPA, AI Act). AI-Enhanced Product Management AI in SDLC: Using AI tools for user story generation, backlog grooming, and documentation. AI for User Insights: Leveraging NLP for sentiment analysis, user feedback clustering, etc. AI-Driven Personalization: Understanding recommendation systems, dynamic content delivery, etc.