Case Manager – Nurse RN

Personify Health

Case Manager RN providing telephonic case management for health insurance plan participants. Ensuring cost-effective, high-quality healthcare through comprehensive assessments and intervention strategies.

Posted 5/14/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $36 - $38 per hourWebsite

About the role

Key responsibilities & impact

Provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants
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
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
Negotiate and implement cost management strategies to affect quality outcomes
Maintain complete and detailed documentation of case managed patients

Requirements

What you’ll need

Graduation from an accredited Registered Nursing (RN) program
Possession of a current California RN license; a multi-state license will also be required
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
Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management
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

Benefits

Comp & perks

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions (yes, we use what we build)
Paid Time Off—rest and recharge time is non-negotiable
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

case managementICD-10 codingCPT codingHCPCS codingtreatment planningclaims processingdischarge planningclinical assessmentcost management strategiespatient advocacy

Soft Skills

interpersonal skillscommunication skillsnegotiation skillsproblem solvingdecision makingcustomer orientationtime managementorganizational skillsindependent workcritical evaluation

Certifications

Registered Nursing (RN) licenseCalifornia RN licensemulti-state RN license