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Case Manager Nurse-RN

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Personify Health

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Location:
United States

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Category:
Nursing

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Contract Type:
Not provided

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Salary:

36.00 - 38.00 USD / Hour
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Job Description:

As a Case Manager RN, you will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. May be required to work evening and/or weekend shifts

Job Responsibility:

  • 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 or family, community resources and multi-disciplinary 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, and multidisciplinary team as needed throughout 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
  • Be able to 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 this data in monthly case management reviews and cost avoidance reports
  • Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information
  • Evaluate and make referrals for wellness programs
  • Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web
  • maintain site specific files ensuring confidentiality
  • prepare reports and updates at 30-day intervals for high-risk cases and 90 days interval for low-risk cases ensuring confidentiality according to Company policy and HIPAA
  • Perform Utilization Review for assigned members
  • Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues

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
  • Knowledge of medical claims and ICD-10, CPT, HCPCS coding
  • 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
What we offer:
  • 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, and financial protection
  • Professional development with clear career progression and learning budgets
  • Mission-driven culture where diverse perspectives drive real impact on people's health

Additional Information:

Job Posted:
March 26, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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