Case Manager, Nurse, RN

🔥 1 minute ago

🏄 California – Remote

🏄 California – Remote

💵 $34 - $36 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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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

• Contact patients directly and complete thorough assessments covering physical, psychosocial, emotional, spiritual, environmental, and financial needs • Use claims processing tools to review paid claim data and identify members needing case management or specific programs • Develop individualized treatment plans for standard and catastrophic cases with patients, caregivers, community resources, and multidisciplinary providers • Set short- and long-term goals • Monitor interventions and evaluate treatment plan effectiveness • Report measurable outcomes • Maintain ongoing contact with patients, families, providers, employers, and the broader care team throughout the continuum of care • Facilitate access to quality care and provide emotional support and guidance • Negotiate and implement cost management approaches • Include cost management impact in monthly case management reviews and cost avoidance reports • Conduct utilization review for assigned members • Evaluate patient needs and make referrals to wellness programs • Maintain complete, confidential documentation in Eldorado and UM Web • Prepare reports at 30-day intervals for high-risk cases and 90-day intervals for low-risk cases according to Company policy and HIPAA • Serve as a clinical resource for LVNs and guide complex case management and clinical decision-making

🎯 Requirements

• Graduate of an accredited Registered Nursing (RN) program • Current California RN license required • Multi-state license also required • Minimum of 5 years medical/surgical or acute care experience, including 2 years in case management, or an equivalent combination of education and experience • Prior case management, emergency room, critical care, or other relevant clinical experience pertinent to case management • Knowledge of medical claims processing and ICD-10, CPT, and HCPCS coding • Ability to critically evaluate claims data to inform treatment and discharge planning • Knowledge of community resources and alternate funding programs • Proficiency with Microsoft Office Suite • Working knowledge of case management platforms such as Eldorado and UM Web

🏖️ Benefits

• Competitive base salary and benefits effective day one • Comprehensive medical and dental through our own health solutions • Paid Time Off • Mental health support • Retirement planning • Financial protection • Professional development with clear career progression and learning budgets • Mission-driven culture where diverse perspectives drive real impact • Wellness programs • Other employee perks • Full benefits package starting day one