Now is the time to join us! 

At Personify Health we value and celebrate diversity and we are committed to creating an inclusive environment for all employees. We believe in creating teams made up of individuals with various backgrounds, experiences, and perspectives. Why? Because diversity inspires innovation, collaboration, and challenges us to produce better solutions. But more than this, diversity is our strength, and a catalyst in our ability to #changelivesforgood.   

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Telephonically manage cases on a long- or short-term basis per established Company guidelines, policies, and procedures, as well as other standardized criteria in the healthcare industry.
• 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 referral 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.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

What you bring to the Personify Health team

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• Graduation from an accredited RN program and possession of a current 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.
• Prefer case management experience, emergent room, critical care background or some other area of clinical care that is pertinent to case management
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding.

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• 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.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

#LI-REMOTE 

Why work at Personify Health?   

We believe a career should provide competitive pay and benefits, a collaborative and supportive culture and cutting-edge technology and services. Virgin Pulse is an equal opportunity organization and is committed to diversity, inclusion, equity and social justice. To that end, we make a particular effort to recruit candidates from minoritized backgrounds to apply for open positions.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $35 to $38 per hour. Note that salary may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.