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Case manager Jobs in Hampton, VA

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Case manager • hampton va

Last updated: 3 days ago

Remote Utilisation Management / Case Management leader (RN/Physician-advisor) - AI Trainer

MercorNewport News, Virginia, US
Remote
Full-time

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems.We are seeking experienced Utilisation Management and Case Management leaders — including ... Show more

Manager

Dunkin'Newport News, VA, United States
Full-time

As a Dunkin' franchisee, we are committed to our employees as much as we are committed to our customers.We value hardworking and enthusiastic employees and we make it a priority to ensure their suc... Show more

HACCP Program Manager / Project Manager

I-2-I Solutions, Inc.Asheville, Durham, Fayetteville, Hampton, Richmond, Salem, Salisbury, VA, US
Full-time
Quick Apply

Position Summary The HACCP Program Manager is the contractor's designated key person for the VISN 6 Water Management / Legionella Testing contract.The solicitation requires this individual to hold ... Show more

RN Case Manager

VHS HospiceNewport News, VA
Full-time

VHS Hospice as an RN Case Manager.Proudly supported by Marquis Health.Full-time, part-time and PRN available!.Locations include: Hampton, Newport News, Williamsburg, Norfolk and Virginia Beach.Prou... Show more

trainee - Case Manager

Peninsula Alcohol Safety Action ProNewport News, VA, US
$38,000.00 yearly
Full-time

NOTE:  This Is Not a State Position.This position will be responsible for conducting intakes, assisting clients, scheduling intervention classes, case reviews, and appointments, requesting status u... Show more

Sales Manager

American Signature, Inc.Newport News, VA, United States
Full-time

Location 12149 Jefferson Avenue, Newport News, VA, 23602, United States.Description Requirements Summary. Show more

Assistant Manager

Papa John'sHampton, VA, US
$38,000.00–$47,000.00 yearly
Full-time

Not much experience???    - - - WE TRAIN - - - .Advance your career in our Level Development Program.Pass a criminal background check.Locally owned and operated for 30 years.We would love to hear f... Show more

Personal Injury Case Manager

The Smith Law CenterHampton, VA, US
$48,000.00 yearly
Full-time

The Smith Law Center has fought for the seriously injured since 1949.For more than 75 years, we’ve stood with individuals and families after life-changing accidents, securing justice in traumatic b... Show more

Assistant Manager

Pizza HutHampton, VA, United States
Full-time

W MERCURY BLVD, Hampton, VA ID#P1-678953-8.Flynn Hut joined the Pizza Hut system in 2021.In 2023, we expanded internationally acquiring Pizza Hut's master franchisee in Australia with 260+ units.To... Show more

Assistant Manager/Co-Manager

Rainbow ShopsNewport News, VA, United States
Full-time

Rainbow USA is recognized as one of the fastest growing junior, kids, plus, and petite, specialty apparel retail chains and has grown to over 1,000 retail stores! We have multiple retail lines that... Show more

Office Manager

Dominion Services For All PeopleHampton, VA, US
$16.50 hourly
Part-time

In this role, you will coordinate all administrative duties and office procedures, ensuring the workplace operates smoothly and efficiently.Your responsibilities will include scheduling meetings, p... Show more

Case Manager

Hampton-Newport News Community Services BoardHampton, VA, USA
Full-time
Quick Apply

Child & Adolescent Intensive Care Coordination.Monday - Friday 8:30 am - 5:00 pm (Some on-call responsibilities).Case Management is a vital part of the H-NNCSB service delivery system, serving ... Show more

General Manager

Zaxby'sNewport News, VA, US
Full-time

Zaxby's is seeking a motivated General Manager in Training to join our growing Zaxby’s team.This role is designed for individuals who want to develop into a General Manager and lead one of our rest... Show more

Assistant Manager

Panda Restaurant GroupNewport News, VA, US
$23.00 hourly
Full-time

Are You Craving A Career With An Industry Leader?.Panda Express is searching for experienced leaders to join our store management team.Panda is 100% committed to the professional and personal devel... Show more

Warehouse Manager

PepsiCoNewport News, VA, United States
Full-time

As a Warehouse Manager, you'll contribute to the success of a plant warehouse location for PepsiCo by coordinating the receiving, shipping, and material handling responsibilities in the warehouse.Y... Show more

Restaurant Manager

Yadav Enterprises - Denny's - VAHampton, Virginia, United States
$50,000.00 yearly
Full-time

Start Your Denny's Career Today!.Restaurant Manager Opportunity.We are looking for GREAT Leaders!.Do you have Management experience?.We are looking for great Leaders to join our Team! Advance your ... Show more

SF Case Manager Hampton

Moms In MotionHampton, VA, US
Full-time

Service Facilitator (SF) Case Manager.Daily local travel to client homes.At Moms In Motion, our Service Facilitators are everyday heroes.You’ll spend your days connecting with families, helping the... Show more

General Manager

Pizza Hut - Flynn GroupNewport News, VA, United States
Full-time

Pizza Hut Restaurant General Manager.Flynn Hut joined the Pizza Hut system in 2021.In 2023, we expanded internationally acquiring Pizza Hut's master franchisee in Australia with 260+ units.Today we... Show more

General Manager

CavaNewport News, VA, United States
Full-time

At CAVA, we make it deliciously simple to eat well and feel good every day.We are guided by a Mediterranean heritage that's been perfecting how to eat and live for four thousand years.We prioritize... Show more

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Remote Utilisation Management / Case Management leader (RN/Physician-advisor) - AI Trainer

Remote Utilisation Management / Case Management leader (RN/Physician-advisor) - AI Trainer

MercorNewport News, Virginia, US
30+ days ago
Job type
  • Full-time
  • Remote
Job description
Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Utilisation Management and Case Management leaders — including RN UM directors, case management managers, and physician advisors — to evaluate AI tools designed to enhance clinical review, medical-necessity determination, and care-coordination workflows. Your clinical and operational expertise will directly shape AI systems that improve utilisation performance, reduce unnecessary care, and support value-based care objectives. **Responsibilities** - Lead utilisation management and/or case management operations, including concurrent review, retrospective review, discharge planning, and care coordination. - Evaluate AI-generated medical necessity determinations, clinical review outputs, and UM decision-support recommendations for accuracy and clinical appropriateness. - Conduct and oversee clinical reviews against InterQual, MCG, or Milliman care guidelines to support admission, continued stay, and level-of-care determinations. - Manage the physician advisor program to support complex UM cases, peer-to-peer review requests, and denial appeals. - Coordinate with clinical teams, payers, and post-acute providers to facilitate appropriate care transitions and discharge planning. - Monitor UM/CM KPIs, including avoidable days, denial rates, observation vs. inpatient conversion rates, and readmission rates. - Ensure compliance with CMS Conditions of Participation, Two-Midnight Rule, and payer-specific UM requirements. - Collaborate with revenue cycle, compliance, and clinical leadership to align UM performance with financial and quality objectives. - Annotate AI outputs and provide structured clinical feedback to support AI training datasets. **Requirements** - 5+ years of experience in utilisation management, case management, or clinical review, with at least 2 years in a leadership role. - Active clinical licensure (RN required; physician advisor/MD preferred) with strong medical necessity review expertise. - Deep knowledge of InterQual, MCG, or Milliman clinical review criteria. - Expertise in CMS Two-Midnight Rule, observation status regulations, and inpatient criteria. - Experience managing physician advisor programs and peer-to-peer review processes with payers. - Exceptional written and verbal English communication skills. - High attention to detail with the ability to critically evaluate clinical documentation and AI-generated UM outputs. **Preferred Qualifications** - CPUR (Certified Professional in Utilisation Review), ACM (Accredited Case Manager), or CCM (Certified Case Manager) credential. - MD or DO with UM/physician advisor experience preferred for physician advisor roles. - Experience with UM software platforms (Allscripts, Utilisation Management software, or equivalent). - Familiarity with AI tools and comfort evaluating AI-generated clinical review content. - Background in health system, ACO, or value-based care organisation UM programs. **Why Join?** - Contribute to the development of frontier AI systems in healthcare. - Collaborate with a world-class AI research organisation. - Gain exposure to cutting-edge AI workflows in utilisation management and clinical decision-support. - Opportunity to work on high-impact projects shaping the future of healthcare AI.