Case Manager, RN

Overview

Now is the time to join us! 

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Responsibilities

Who are you?

As a Case Manager you will offer telephonic case management for members experiencing severe or chronic health conditions. We are actively recruiting for on-site Telephonic Case Managers who provide patient education, emotional support, and assistance with care coordination.

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Coordinate care and services and develop patient treatment plans for catastrophic cases.
• Telephonically manage cases on a long or short-term basis per established company guidelines, policies and procedures, as well as other standardized criteria in the healthcare industry.
• Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Develop treatment plan in collaboration with the patient, caregivers or family, community resources and multidisciplinary healthcare providers that include obtainable short and long term goals. Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
• Initiate and maintain contact with the patient/family, provider, employer group, and multidisciplinary team as needed through the continuum of care.
• Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
• Meet daily productivity requirement.
• Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
• Perform data entry and maintain complete and detailed documentation of case managed patient in the computer system; maintain site specific logs and files, ensuring confidentiality according to company policy and HIPAA.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Qualifications

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• Current unrestricted RN license 
• California license (preferred)
• 1+ years of case management experience required.
• Computer proficiency and working knowledge of Microsoft Office Suite and Microsoft Outlook required.
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding preferred.
• Knowledge of utilization management/quality management case philosophies and reporting requirements; quality improvement methodologies preferred.

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• Ability to critically evaluate claims data and determine treatment plan; discharge planning experience.
• Ability to work independently making decisions and problem solving
• Knowledge of community resources and alternate funding programs.
• Computer proficiency or working knowledge of Microsoft Office Suite.
• Excellent interpersonal, communication and negotiation skills.
• Strong customer orientation.
• Good time management skills and highly organized.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $32 to $36 per hour. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to [email protected]. All of our legitimate openings can be found on the Personify Health Career Site.

Application Deadline: May 23,2025