Case Manager Nurse, RN (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

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.

 

What makes this role different

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.

What You'll Actually Do

Essential Functions/Responsibilities/Duties

• 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.

Qualifications

What You Bring to Our Mission

Education and Experience

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

 

Required Knowledge, Skills, and Abilities

• 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.