Chronic Disease Case Manager Nurse-RN

Personify Health

3d • Remote

About The Position

Personify Health created the first and only personalized health platform, integrating health plan administration, holistic wellbeing solutions, and comprehensive care navigation. This platform serves employers, health plans, and health systems with data-driven solutions aimed at reducing costs and improving health outcomes. The team is dedicated to empowering people to lead healthier lives.

Requirements

• Graduate of an accredited Registered Nurse (RN) program with a current, unrestricted Registered Nurse license issued in the United States.
• The organization may require additional state licensure(s) to meet operational and business needs.
• California, Washington and Oregon Licenses required after hire.
• Prior experience in case management, wellness or disease management coordination, or an equivalent combination of education, clinical training, and relevant professional experience.
• Demonstrated ability to apply clinical knowledge in a managed care, population health, or remote healthcare environment.
• Willingness to travel.
• Basic computer literacy with the ability to navigate multiple systems simultaneously.
• Ability to work on multiple screens with proficient typing skills.
• Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Microsoft Outlook.
• Strong verbal and written communication skills, including the ability to clearly explain complex or technical information and accurately interpret information received from others.
• Ability to work independently, manage time effectively, utilize written resources to problem-solve and make informed decisions.
• Foundational knowledge of medical claims processing and medical terminology, including ICD10, CPT, and HCPCS coding.
• After completion of initial training and a structured ramp period (approximately three [3] months total), demonstrate proficiency in required systems and tools, including but not limited to: Microsoft Teams (on- and off-camera), SharePoint, shared drives, VPN, UM Web, Health Notes, MyCare, ADP, Confluence, Phone system with headset.
• Ability to quickly adapt to additional systems or tools as job responsibilities evolve.

Responsibilities

• Telephonically coordinate wellness and disease management for members with chronic conditions, including but not limited to diabetes, asthma, COPD, CAD, CHF, atrial fibrillation, hypertension, and hyperlipidemia.
• Proactively contact targeted members to promote health and restore optimal functioning by applying nationally recognized care guidelines and comparing current care with industry standards.
• Review gaps in care and medical and pharmacy paid claims data to develop a comprehensive clinical profile; create individualized care plans and provide close follow-up for actively managed patients.
• Collaborate with members to ensure assignment to a primary care provider; facilitate referrals to specialists as needed; assist with obtaining durable medical equipment and reviewing pricing for high-cost medications.
• Support the Utilization Review process for assigned members in accordance with organizational and regulatory standards.
• Assess member needs and initiate referrals to case management, prenatal, wellness programs, and external vendor services as appropriate.
• Maintain complete, accurate, and timely documentation of case-managed members in designated systems; document all interventions and patient contacts while ensuring confidentiality and privacy of member records.
• Track and monitor moderate and high-risk member populations and associated interventions to demonstrate improvements in overall health outcomes.
• Meet established productivity, quality, and turnaround time standards on a daily, weekly, monthly basis.
• Successfully participate in and pass external audits, including NCQA and URAC.
• Maintain HIPAA compliance and confidentiality requirements in accordance with company policies and procedures.
• Complete all required annual training within designated timeframes.

Benefits

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions
• Paid Time Off—rest and recharge time is non-negotiable
• 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 on people's health
• Full benefits package starting day one

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree