Chronic Disease Management-RN

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

 

What makes this role different

 

As a Full-Time Disease Management Nurse, you will telephonically coordinate wellness and disease management, with a primary focus on conditions such as diabetes, asthma, COPD, CAD, CHF, atrial fibrillation, hypertension, and hyperlipidemia but not limited to this list.

 

 

What You'll Actually Do

• Contact targeted member for health promotion and restoration by the use of national care guidelines to compare patient’s current level of care with industry standards.
• Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health; create an individual care plan for each patient; provide close follow-up with patients actively managed.
• Work with patients to ensure they have a primary care provider; assist in referrals to specialists if needed; assist in obtaining durable medical equipment, review pricing for high-cost drugs.
• Evaluate and make referrals for case management, prenatal program or pharmacology review as indicated.
• Document interventions and patient contact; maintain privacy of member’s records and assist in providing quarterly reports to clients.
• Track groups of high-risk members and interventions to show overall health improvement within the organization.
• Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.

 

Qualifications

What You Bring to Our Mission

 

Essential Functions/Responsibilities/Duties

• Contact targeted member for health promotion and restoration by the use of national care guidelines to compare patient’s current level of care with industry standards.
• Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health; create an individual care plan for each patient; provide close follow-up with patients actively managed.
• Work with patients to ensure they have a primary care provider; assist in referrals to specialists if needed; assist in obtaining durable medical equipment, review pricing for high-cost drugs.
• Evaluate and make referrals for case management, prenatal program or pharmacology review as indicated.
• Document interventions and patient contact; maintain privacy of member’s records and assist in providing quarterly reports to clients.
• Track groups of high-risk members and interventions to show overall health improvement within the organization.
• Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.

Education and Experience

• Graduation from an accredited RN program and possession of a current United States RN license. May require additional licensing as business needs change.
• Prior experience in case management, coordinating wellness programs, or an equivalent combination of education and experience.

 

Required Knowledge, Skills, and Abilities

• Strong written and verbal communication skills
• Proficient in Microsoft Excel, Word, PowerPoint and Outlook
• Demonstrate ability to work independently with excellent judgment
• Excellent interpersonal and communication skills including able to give presentations to groups and individuals as needed.
• Good time management skills, highly organized.

Why You'll Love It Here

We believe in total rewards that actually matter—not just competitive packages, but benefits that support how you want to live and work.

 

Your wellbeing comes first:

• 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

 

Financial security that makes sense:

• 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 protec