Public Policy Manager
Persona
Case Manager, RN
Personify Health
full-time
Posted on:
Location: California • 🇺🇸 United States
Visit company websiteSalary
💰 $32 - $36 per hour
Job Level
Junior
About the role
- Telephonic case management for members experiencing severe or chronic health conditions
- Coordinate care and services and develop patient treatment plans for catastrophic cases
- Telephonically manage cases long or short-term per company guidelines
- Complete thorough assessments including physical, psychosocial, emotional, spiritual, environmental, and financial needs
- Develop treatment plan in collaboration with patient, caregivers, community resources and multidisciplinary providers
- Monitor interventions and evaluate effectiveness; report measurable outcomes
- Maintain contact with patient/family, provider, employer group, and multidisciplinary team
- Advocate for patient, provide emotional support and guidance, and assist in reducing costs
- Negotiate and implement cost management strategies; maintain monthly case management reviews and cost avoidance reports
- Perform data entry and maintain documentation; ensure confidentiality according to HIPAA
Requirements
- Current unrestricted RN license
- California license (preferred)
- 1+ years of case management experience required
- Computer proficiency and working knowledge of Microsoft Office Suite and Microsoft Outlook required
- Knowledge of medical claims and ICD-10, CPT, HCPCS coding preferred
- Knowledge of utilization management/quality management case philosophies and reporting requirements; quality improvement methodologies preferred
- 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
- Excellent interpersonal, communication and negotiation skills
- Strong customer orientation
- Good time management skills and highly organized
