Case Manager Nurse (RN)

2w2 weeks ago

Personify Health

US · Full-time · $72,000 – $76,000

About this role

Personify Health created the first and only personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while improving health outcomes.

As a Case Manager RN, you will provide telephonic case management between providers, patients, and caregivers to ensure cost-effective, high-quality healthcare for health insurance plan participants. This role offers flexibility and is ideal for candidates seeking reduced hours while making a meaningful impact.

You will contact patients to complete thorough assessments covering physical, psychosocial, emotional, spiritual, environmental, and financial needs. Using claims processing tools, you will review paid claim data to develop a clinical picture of a member’s health and identify appropriate program participation.

You will collaborate with patients, caregivers, community resources, and multidisciplinary healthcare providers to develop treatment plans with obtainable short- and long-term goals. Monitoring interventions and evaluating effectiveness, you will report measurable outcomes and advocate for patients by facilitating quality care and reducing overall costs.

Requirements

Graduation from an accredited Registered Nursing (RN) program.
Possession of a current California RN license; a multi-state license will also be required.
Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience.
Prior case management experience, emergency room, critical care background, or other relevant clinical care experience pertinent to case management.
Ability to use claims processing tools and review paid claim data to develop clinical picture of member health.
Strong documentation skills and ability to maintain confidentiality per HIPAA and company policy.

Responsibilities

Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs.
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers, community resources, and multi-disciplinary healthcare providers.
Monitor interventions and evaluate the effectiveness of the treatment plan; report measurable outcomes that record effectiveness of interventions.
Advocate for the patient by facilitating the delivery of quality patient care and assisting in reducing overall costs; provide patient/family with emotional support and guidance.
Meet productivity, quality, and turnaround time requirements on a daily, weekly, and monthly basis.
Negotiate and implement cost management strategies to affect quality outcomes and reflect data in monthly case management reviews and cost avoidance reports.
Maintain complete and detailed documentation of case managed patients, ensuring confidentiality according to Company policy and HIPAA.

Benefits

Flexible schedule with reduced hours ideal for work-life balance.
Remote telephonic work opportunity from anywhere in the US.
Opportunity to make a direct impact on patient outcomes and healthcare quality.
Collaboration with a multidisciplinary team of healthcare providers and community resources.