Personify Health

Case Manager, RN

Posted on

March 12, 2025

Job Type

Full-Time

Role Type

Case Management

License

RN

State License

California

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Company Description

We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. 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.

Job Description

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.

Requirements

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.

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Responsibilities

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.

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