Case Manager Nurse, RN (PART-TIME)

Personify Health

1d•$36 - $38

About The Position

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. We are seeking Case Manager Nurse, RN to join our team on a part-time basis, working up to 25 hours per week. In this role, you will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. This position offers flexibility and is ideal for candidates looking for reduced hours while making an impact within the team. Evening and weekend availability may be required. At Personify Health we value and celebrate diversity, and we are committed to creating an inclusive environment for all employees. We believe in creating teams made up of individuals with various backgrounds, experiences, and perspectives. Why? Because diversity inspires innovation, collaboration, and challenges us to produce better solutions. But more than this, diversity is our strength, and a catalyst in our ability to change lives for the good.

Requirements

Graduation from an accredited RN program and possession of a current California RN license.
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.
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.
Must be able to remain in a stationary position 50% of the time.
The person in this job needs to occasionally move about inside the office to access office machinery, filing cabinets and meeting facilities.
Constantly operates a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc.
Frequently positions self to maintain files in file cabinets.
Frequently moves boxes or equipment weighing up to 25 pounds.
Must communicate information and ideas so others understand. Must be able to exchange accurate information in these situations.
Must be able to observe details at close range.

Nice To Haves

Prefer case management experience, emergency room, critical care background or some other area of clinical care that is pertinent to case management.

Responsibilities

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.

Benefits

Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!)
Mental health support and wellness programs designed by experts who get it
Flexible work arrangements that fit your life, not the other way around
Retirement planning support to help you build real wealth for the future
Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage
Professional development opportunities and clear career progression paths
Mentorship from industry leaders who want to see you succeed
Learning budget to invest in skills that matter to your future
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
Competitive base salary that rewards your success
PTO policy because rest and recharge time is non-negotiable
Benefits effective day one—because you shouldn’t have to wait to be taken care of