Case Manager, RN
Personify Health
Salary
💰 $32 - $36 per hour
Job Level
Junior
About the role
- Provide telephonic case management and patient education for members with severe or chronic conditions
- Coordinate care and services and develop patient treatment plans for catastrophic cases
- Telephonically manage cases long or short-term per company guidelines and industry criteria
- Contact patients and complete thorough assessments (physical, psychosocial, emotional, spiritual, environmental, financial)
- Develop treatment plans in collaboration with patients, caregivers, community resources and multidisciplinary providers
- Monitor interventions, evaluate effectiveness, and report measurable outcomes
- Initiate and maintain contact with patients/families, providers, employer groups, and multidisciplinary teams
- Advocate for patients to facilitate quality care and reduce costs; provide emotional support and guidance
- Meet daily productivity requirements
- Negotiate and implement cost management strategies and report cost avoidance
- Perform data entry and maintain complete documentation; maintain 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
- 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
