Case Management Nurse, RN

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $35 - $37 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 1 day.
• Jobs at this company usually fill in 21 days.

Apply Now

Check your resume score

Customize resume + cover letter

Find Similar Remote Jobs

☆ Save☑️ Mark as applied❌ Hide

Report problem

Personify Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2023

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Personify Health is the first personalized health platform company, designed to empower individuals and organizations to achieve better health outcomes through tailored solutions and services. They offer a comprehensive range of solutions including wellbeing navigation, care management, and health plan administration, catering to employers, health systems, health plans, and brokers. Their goal is to simplify healthcare experiences and enhance engagement, ultimately helping businesses optimize their investment in employee health and wellbeing.

📋 Description

• Manage short- and long-term cases by phone according to company guidelines, policies, and industry criteria • Conduct comprehensive biopsychosocial assessments • Review paid claims using claims-processing tools and determine case-management eligibility • Develop and update individualized treatment plans with measurable goals • Evaluate intervention effectiveness and document clinical outcomes and cost savings • Communicate with members, caregivers, providers, employers, and multidisciplinary teams • Advocate for quality patient care, appropriate utilization, and reduced healthcare costs • Refer members to chronic disease, wellness, behavioral health, and vendor-specific programs • Implement cost-management strategies and document results • Assist with Utilization Review • Coach LVNs and LPNs and support complex case guidance within licensure scope • Serve as a subject-matter expert on NCQA, URAC, and CMSA standards and documentation practices • Maintain compliance with CMS, regulatory audit standards, company policy, and HIPAA • Maintain accurate and confidential records • Meet productivity, quality, and turnaround standards • Complete required annual education and competencies

🎯 Requirements

• Graduate of an accredited nursing program • Current RN license required based on business need • 3 years of medical/surgical or acute care experience • Working knowledge of NCQA, URAC, CMSA, and CMS standards and HIPAA requirements • Knowledge of medical claims and ICD-10, CPT, and HCPCS coding • Proficiency in Microsoft Word, Excel, and Outlook • Basic computer literacy • Proficient typing • Ability to work across multiple screens • Proficiency in Teams, SharePoint, shared drives, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Smartsheet, and a phone system with headset • Full system proficiency expected after training and a 1.5-month ramp (3 months total)

🏖️ Benefits

• Competitive base salary • Benefits effective day one • Comprehensive medical and dental coverage • Paid Time Off • Mental health support • Retirement planning • Financial protection • Professional development • Clear career progression • Learning budgets • Wellness programs • Other employee perks

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume