Care Manager RN (Remote)

Location: Remote from Pennsylvania, United States; physical work site required

Company

hirify.global provides healthcare services and manages care for members through provider and health plan operations.

What you will do

• Review the appropriateness and efficiency of healthcare services using established criteria, medical policies, and care management guidelines.
• Identify and refer members who may benefit from health coaching or case management interventions.
• Develop collaborative interventions to improve member healthcare outcomes and address quality issues.
• Educate members, providers, facilities, and vendors while improving care management processes and provider relationships.
• Monitor care delivery and use qualitative and quantitative outcomes data to develop improvement strategies.
• Respond to customer inquiries and recommend appropriate interventions or alternatives.

Requirements

• Current Pennsylvania RN licensure or current multi-state licensure through the enhanced Nurse Licensure Compact is required.
• Additional state licenses may be required depending on where clinical care is provided.
• At least three years of related progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• Working knowledge of regulatory and compliance requirements and medical policies.
• Strong communication, analytical, organizational, prioritization, and computer skills.

Nice to have

• Bachelor’s degree in Nursing.
• Experience in utilization management, care management, quality assurance, or managed care.
• Certification in utilization management or a related field.

Culture & Benefits

• Remote work arrangement with a physical work site requirement in Pennsylvania.
• Travel requirement of 0%–25%.
• Work includes protecting confidential customer information and complying with HIPAA, privacy, security, ethical, and legal standards.
• Fast-paced environment requiring flexibility, multitasking, and deadline management.