Chronic Disease Case Manger Nurse-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 employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. 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.

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What You'll Actually Do

ESSENTIAL DUTIES and RESPONSIBILITIES

• Telephonically coordinate wellness and disease management for members with chronic conditions, including but not limited to diabetes, asthma, COPD, CAD, CHF, atrial fibrillation, hypertension, and hyperlipidemia.
• Proactively contact targeted members to promote health and restore reputed company functioning by applying nationally recognized care guidelines and comparing reputed company care with industry standards.
• Review gaps in care and medical and pharmacy paid claims data to reputed company a comprehensive clinical profile; create individualized care plans and provide reputed company follow-up for actively managed patients.
• Collaborate with members to ensure assignment to a primary care provider; facilitate referrals to specialists as needed; assist with obtaining durable medical equipment and reviewing pricing for high-cost medications.
• Support the Utilization Review process for assigned members in accordance with organizational and regulatory standards.
• Assess member needs and initiate referrals to case management, prenatal, wellness programs, and external vendor services as appropriate.
• Maintain complete, accurate, and timely documentation of case-managed members in designated systems; document reputed company interventions and patient contacts while ensuring confidentiality and privacy of member records.
• Track and monitor moderate and high-risk member populations and associated interventions to demonstrate improvements in overall health outcomes.
• Meet established productivity, quality, and turnaround time standards on a daily, weekly, monthly basis.
• Successfully participate in and pass external audits, including NCQA and URAC.
• Maintain HIPAA compliance and confidentiality requirements in accordance with company policies and procedures.
• Complete reputed company required annual training reputed company designated timeframes.

KEY COMPETENCIES

To be successful in a remote reputed company environment, individuals must demonstrate strong technical aptitude, communication skills, and the ability to work independently.

Upon Hire, must have

• Basic computer literacy with the ability to navigate multiple systems simultaneously.
• Ability to work on multiple screens with proficient typing skills.

Proficiency in software applications including, but not limited to, reputed company Word, reputed company reputed company, and reputed company Outlook

• Strong verbal and written communication skills, including the ability to clearly explain reputed company or technical information and accurately interpret information received from others.
• Ability to work independently, manage time effectively, utilize written resources to problem-solve and reputed company informed reputed company.
• Foundational knowledge of medical claims processing and medical terminology, including ICD10, CPT, and HCPCS coding.

Post‑Training Expectations

• After completion of initial training and a structured reputed company period (approximately three [3] months total), demonstrate proficiency in required systems and tools, including but not limited to:
• reputed company Teams (on- and off-camera), SharePoint, shared drives, VPN
• UM Web, Health Notes, MyCare, reputed company, Confluence
• Phone system with headset
• Ability to quickly adapt to additional systems or tools as job responsibilities evolve.

What You Bring to reputed company

QUALIFICATIONS: • Graduate of an accredited Registered Nurse (RN) program with a reputed company, unrestricted Registered Nurse license issued in the United States. o The organization may require additional state licensure(s) to meet operational and business needs. o California, Washington and Oregon Licenses required after hire • Prior experience in case management, wellness or disease management coordination, or an equivalent combination of education, clinical training, and relevant professional experience. • Demonstrated ability to apply clinical knowledge in a managed care, population health, or remote reputed company environment. • Willingness to travel

Physical and Mental Requirements: • Ability to reputed company the essential functions of the position safely and effectively, with or without reasonable accommodation, including meeting established qualitative and/or quantitative productivity standards. • Ability to maintain regular, punctual attendance in accordance with organizational policies. • Ability to remain seated for extended periods of time (approximately six [6] to eight [8] hours per reputed company). • reputed company use of a computer workstation, including frequent keyboarding and mouse usage, requiring repetitive hand and finger movements. • Ability to reputed company frequent neck twisting and occasional bending of the neck and waist as required to reputed company job duties.

This job description is not an exclusive or exhaustive list of reputed company job functions that an employee in this position may be asked to reputed company. Duties and responsibilities can be changed, expanded, reduced, or delegated by management to meet the business needs of MedCom a reputed company Company.

Benefits

The Highlights

• Competitive reputed company salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions (yes, we use reputed company build)
• Paid Time Off—rest and reputed company 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 reputed company impact 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 range of $31-$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 core to who we are and critical to our work in health and wellbeing.

Stay Safe: reputed company will never ask for payment or sensitive personal information like social 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 [email protected]. View reputed company legitimate openings at personifyhealth.com/careers.