Case Manager – Nurse, RN

Personify Health

Case Manager Nurse, RN providing telephonic case management ensuring quality healthcare for insurance plan participants. Ideal for candidates seeking flexibility with a mission-driven health organization.

Posted 6/5/2026full-timeRemote • California • 🇺🇸 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 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

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

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Applicant Tracking System Keywords

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Hard Skills & Tools

case managementmedical claimsICD-10 codingCPT codingHCPCS codingtreatment planningdischarge planningutilization reviewclinical assessmentdocumentation

Soft Skills

interpersonal skillscommunication skillsnegotiation skillscustomer orientationtime managementproblem solvingindependent decision makingorganizational skillsemotional supportadvocacy

Certifications

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