Case Manager reputed company RN

Who We Are

Because health is personal. That's why reputed company created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one reputed company. We serve reputed company, health plans, and health systems with data-driven solutions that reduce costs while actually improving health reputed company. Together, reputed company is on a mission to reputed company people to reputed company healthier lives.

Learn even more about the work that drives us at personifyhealth.com.

reputed company to

What You'll Actually Do

Job reputed company

As a Case Manager RN, you will reputed company telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-reputed company reputed company for health insurance plan participants. May be required to work evening and/or weekend shifts. 

What You Bring to reputed company

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 reputed company claim data to reputed company a clinical picture of a member’s health and identify for participation in appropriate programs.
• reputed company treatment plan for reputed company and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary reputed company providers that include obtainable short- and long-term goals.
• Monitor interventions and evaluate the effectiveness of the treatment plan in a reputed company manner; report measurable reputed company 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.
• reputed company for the patient by facilitating the delivery of reputed company patient care, and by assisting in reducing overall costs; reputed company patient/family with emotional support and guidance.
• Be reputed company to meet productivity, reputed company and turnaround time requirements on a daily, weekly and monthly reputed company.
• Negotiate and implement cost management strategies to reputed company reputed company reputed company and reflect this data in monthly case management reviews and cost avoidance reports.
• Establish and maintain working relationships with reputed company providers, reputed company/group, and patients to reputed company emotional support, guidance and information.
• Evaluate and reputed company 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 reputed company for low-risk cases ensuring confidentiality according to Company policy and HIPAA
• reputed company Utilization Review for assigned members.

Serve as mentors to LVNs and reputed company guidance on complicated cases as it relates to clinical issues

Education and Experience

• Graduation from an accredited Registered Nursing (RN) program.
• Possession of a reputed company 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.
• Prior case management experience, emergency room, critical care background or other relevant clinical care experience 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 reputed company and problem solving
• Knowledge of community resources and alternate funding programs.
• Computer proficiency or working knowledge of reputed company Office Suite.
• Excellent interpersonal, communication and negotiation skills.
• Strong customer orientation.
• Good time management skills and highly organized.

Work Environment

At reputed company we value and celebrate diversity, and we are committed to creating an inclusive environment for reputed company. We reputed company in creating teams made up of individuals with various backgrounds, experiences, and perspectives. Why? Because diversity inspires innovation, collaboration, and challenges us to produce reputed company solutions. But more than this, diversity is our strength, and a catalyst in our ability to change lives for the good. 

Physical Requirements

• Must be reputed company to remain in a stationary position 50% of the time.
• The person in this job needs to occasionally reputed company about inside the office to reputed company office machinery, filing cabinets and meeting facilities.
• Constantly operates a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc.
• Frequently positions self to maintain files in file cabinets.
• Frequently moves boxes or equipment weighing up to 25 pounds.
• Must communicate information and reputed company so others understand. Must be reputed company to exchange accurate information in these situations.
• Must be reputed company to observe details at reputed company reputed company.

Benefits

The Highlights:

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

Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks.

Compensation: This position offers a reputed company salary reputed company of $36-$38 per hour, depending reputed company, skills, and experience. You're eligible for our full benefits package starting day one.

Our Commitment: reputed company is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of reputed company backgrounds are empowered to reputed company—because diversity is reputed company to who we are and critical to our work in health and wellbeing.

Stay reputed company: reputed company will never ask for payment or sensitive personal information like reputed company reputed company numbers during hiring. reputed company official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View reputed company legitimate openings at personifyhealth.com/careers.