Chronic Disease Case Manager Nurse - RN

1w1 week ago

Personify Health

US · Full-time · $62,000 – $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. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while improving health outcomes. Our team empowers people to lead healthier lives.

As a Chronic Disease Case Manager Nurse-RN, telephonically coordinate wellness and disease management for members with chronic conditions like diabetes, asthma, COPD, CAD, CHF, atrial fibrillation, hypertension, and hyperlipidemia. Proactively contact targeted members to promote health using nationally recognized care guidelines. Review gaps in care and claims data to develop individualized care plans with close follow-up.

Work in a remote healthcare environment requiring strong technical aptitude, communication skills, and independent operation. Navigate multiple systems simultaneously on multiple screens with proficient typing. Collaborate with members on primary care assignment, specialist referrals, durable medical equipment, and high-cost medication pricing.

Track moderate and high-risk members to demonstrate health outcome improvements while meeting productivity, quality, and turnaround standards. Participate in external audits like NCQA and URAC, maintaining HIPAA compliance. Complete required annual training to support ongoing mission success.

Requirements

Basic computer literacy with the ability to navigate multiple systems simultaneously
Ability to work on multiple screens with proficient typing skills
Proficiency in software applications including Microsoft Word, Microsoft Excel, and Microsoft Outlook
Strong verbal and written communication skills to explain complex information
Ability to work independently, manage time effectively, and utilize written resources to problem-solve
Foundational knowledge of medical claims processing and medical terminology including ICD10, CPT, and HCPCS coding
Active RN license suitable for telephonic chronic disease case management
Familiarity with chronic conditions such as diabetes, asthma, COPD, CAD, CHF, hypertension, and hyperlipidemia

Responsibilities

Telephonically coordinate wellness and disease management for members with chronic conditions including diabetes, asthma, COPD, CAD, CHF, atrial fibrillation, hypertension, and hyperlipidemia
Proactively contact targeted members to promote health and restore optimal functioning by applying nationally recognized care guidelines
Review gaps in care and medical and pharmacy paid claims data to develop comprehensive clinical profiles and individualized care plans
Collaborate with members to ensure assignment to a primary care provider and facilitate referrals to specialists as needed
Support the Utilization Review process for assigned members in accordance with organizational and regulatory standards
Assess member needs and initiate referrals to case management, prenatal, wellness programs, and external vendor services
Maintain complete, accurate, and timely documentation of case-managed members while ensuring confidentiality
Track and monitor moderate and high-risk member populations to demonstrate improvements in health outcomes