Case Management, RN

Job Description

Part Time Case Management, RN Job LocationsUS-Remote Job ID 2025-4269 Category Care Management Type Part-Time Overview Who We Are 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 Ready to Be the Clinical Navigator Who Transforms Healthcare Journeys? We’re seeking a compassionate RN who can provide telephonic case management that bridges the gap between providers, patients, and caregivers. As our Case Manager RN, you’ll ensure cost-effective, high-quality healthcare for plan participants while advocating for optimal patient outcomes through strategic care coordination and clinical expertise. What makes this role different ✓ Comprehensive assessment expertise: Conduct thorough evaluations encompassing physical, psychosocial, emotional, spiritual, environmental, and financial needs ✓ Clinical detective work: Use claims processing tools to review paid claim data and develop complete clinical pictures for program participation ✓ Care coordination leadership: Develop treatment plans for standard and catastrophic cases in collaboration with multidisciplinary healthcare teams ✓ Mentorship opportunity: Guide LVNs and provide clinical expertise on complicated cases while building professional relationships What You’ll Actually Do Conduct comprehensive assessments: Contact patients and complete thorough evaluations including physical, psychosocial, emotional, spiritual, environmental, and financial needs analysis. Develop strategic treatment plans: Create collaborative plans for standard and catastrophic cases with patients, caregivers, community resources, and multidisciplinary healthcare providers including achievable short- and long-term goals. Monitor and evaluate outcomes: Track intervention effectiveness in timely manner while reporting measurable outcomes that demonstrate intervention success and clinical value. Advocate for patient care: Facilitate delivery of quality patient care while assisting in cost reduction and providing emotional support and guidance to patients and families. Implement cost management strategies: Negotiate and execute strategies that affect quality outcomes while documenting data in monthly case management reviews and cost avoidance reports. Maintain clinical documentation: Complete detailed documentation in Eldorado and UM Web while maintaining site-specific files ensuring confidentiality and preparing regular reports according to Company policy and HIPAA requirements. Qualifications What You Bring to Our Mission The clinical foundation: Graduation from accredited Registered Nursing (RN) program Current California RN license; multi-state license also required Minimum 5 years medical/surgical or acute care experience including 2 years case management experience Prior case management, emergency room, critical care, or relevant clinical care experience The technical expertise: Knowledge of medical claims and ICD-10, CPT, HCPCS coding Ability to critically evaluate claims data and determine treatment plans with discharge planning experience Computer proficiency with working knowledge of Microsoft Office Suite Knowledge of community resources and alternate funding programs The professional competencies: Ability to work independently while making clinical decisions and problem-solving complex cases Excellent interpersonal, communication, and negotiation skills with strong customer orientation Good time management skills with highly organized approach to multiple case coordination Capability to meet productivity, quality, and turnaround time requirements on daily, weekly, and monthly basis Why You’ll Love It Here We believe in creating meaningful work experiences that fit your life—whether you’re building your career, balancing other commitments, or seeking purposeful part-time opportunities. Flexibility that actually works: Part-time schedule Remote work that eliminates commute stress Clear expectations and boundaries that respect your time investment Growth without limits: Access to learning and development opportunities alongside full-time colleagues Mentorship and skill-building that translates to career advancement A culture that energizes: People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges We Deliver: Mission-driven work that creates real impact on people’s health and wellbeing, with clear accountability for results Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable The practical stuff: Competitive hourly compensation that values your expertise Technology and equipment support to set you up for success Ready to create a healthier world? We’re ready for you. 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 $34 to $36 per hour. Note that compensation may vary based on location, skills, and experience. This position is part time and therefore not eligible for 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 Part Time Case Management, RN Job LocationsUS-Remote Job ID 2025-4269 Category Care Management Type Part-Time Who We Are Who We Are 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. Ready to Be the Clinical Navigator Who Transforms Healthcare Journeys? We’re seeking a compassionate RN who can provide telephonic case management that bridges the gap between providers, patients, and caregivers. As our Case Manager RN, you’ll ensure cost-effective, high-quality healthcare for plan participants while advocating for optimal patient outcomes through strategic care coordination and clinical expertise. What makes this role different What makes this role different ✓ Comprehensive assessment expertise: Conduct thorough evaluations encompassing physical, psychosocial, emotional, spiritual, environmental, and financial needs Comprehensive assessment expertise: ✓ Clinical detective work: Use claims processing tools to review paid claim data and develop complete clinical pictures for program participation Clinical detective work: ✓ Care coordination leadership: Develop treatment plans for standard and catastrophic cases in collaboration with multidisciplinary healthcare teams Care coordination leadership: ✓ Mentorship opportunity: Guide LVNs and provide clinical expertise on complicated cases while building professional relationships Mentorship opportunity: What You’ll Actually Do Conduct comprehensive assessments: Contact patients and complete thorough evaluations including physical, psychosocial, emotional, spiritual, environmental, and financial needs analysis. Conduct comprehensive assessments: Develop strategic treatment plans: Create collaborative plans for standard and catastrophic cases with patients, caregivers, community resources, and multidisciplinary healthcare providers including achievable short- and long-term goals. Develop strategic treatment plans: Monitor and evaluate outcomes: Track intervention effectiveness in timely manner while reporting measurable outcomes that demonstrate intervention success and clinical value. Monitor and evaluate outcomes: Advocate for patient care: Facilitate delivery of quality patient care while assisting in cost reduction and providing emotional support and guidance to patients and families. Advocate for patient care: Implement cost management strategies: Negotiate and execute strategies that affect quality outcomes while documenting data in monthly case management reviews and cost avoidance reports. Implement cost management strategies: Maintain clinical documentation: Complete detailed documentation in Eldorado and UM Web while maintaining site-specific files ensuring confidentiality and preparing regular reports according to Company policy and HIPAA requirements. Maintain clinical documentation: What You Bring to Our Mission What You Bring to Our Mission The clinical foundation: The clinical foundation: Graduation from accredited Registered Nursing (RN) program Current California RN license; multi-state license also required Minimum 5 years medical/surgical or acute care experience including 2 years case management experience Prior case management, emergency room, critical care, or relevant clinical care experience Graduation from accredited Registered Nursing (RN) program Current California RN license; multi-state license also required Minimum 5 years medical/surgical or acute care experience including 2 years case management experience Prior case management, emergency room, critical care, or relevant clinical care experience The technical expertise: The technical expertise: Knowledge of medical claims and ICD-10, CPT, HCPCS coding Ability to critically evaluate claims data and determine treatment plans with discharge planning experience Computer proficiency with working knowledge of Microsoft Office Suite Knowledge of community resources and alternate funding programs Knowledge of medical claims and ICD-10, CPT, HCPCS coding Ability to critically evaluate claims data and determine treatment plans with discharge planning experience Computer proficiency with working knowledge of Microsoft Office Suite Knowledge of community resources and alternate funding programs The professional competencies: The professional competencies: Ability to work independently while making clinical decisions and problem-solving complex cases Excellent interpersonal, communication, and negotiation skills with strong customer orientation Good time management skills with highly organized approach to multiple case coordination Capability to meet productivity, quality, and turnaround time requirements on daily, weekly, and monthly basis Ability to work independently while making clinical decisions and problem-solving complex cases Excellent interpersonal, communication, and negotiation skills with strong customer orientation Good time management skills with highly organized approach to multiple case coordination Capability to meet productivity, quality, and turnaround time requirements on daily, weekly, and monthly basis Why You’ll Love It Here Why You’ll Love It Here We believe in creating meaningful work experiences that fit your life—whether you’re building your career, balancing other commitments, or seeking purposeful part-time opportunities. Flexibility that actually works: Flexibility that actually works: Part-time schedule Remote work that eliminates commute stress Clear expectations and boundaries that respect your time investment Part-time schedule Remote work that eliminates commute stress Clear expectations and boundaries that respect your time investment Growth without limits: Growth without limits: Access to learning and development opportunities alongside full-time colleagues Mentorship and skill-building that translates to career advancement Access to learning and development opportunities alongside full-time colleagues Mentorship and skill-building that translates to career advancement A culture that energizes: A culture that energizes: People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges We Deliver: Mission-driven work that creates real impact on people’s health and wellbeing, with clear accountability for results Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation People Matter: One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges One Team One Dream: We Deliver: Mission-driven work that creates real impact on people’s health and wellbeing, with clear accountability for results We Deliver: Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable Grow Forward: The practical stuff: The practical stuff: Competitive hourly compensation that values your expertise Technology and equipment support to set you up for success Competitive hourly compensation that values your expertise Technology and equipment support to set you up for success Ready to create a healthier world? We’re ready for you. Ready to create a healthier world? 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! 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 $34 to $36 per hour. Note that compensation may vary based on location, skills, and experience. This position is part time and therefore not eligible for benefits. In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $34 to $36 per hour. Note that compensation may vary based on location, skills, and experience. This position is part time and therefore not eligible for benefits. not 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