Senior Case Manager RN (Remote)

Location: Remote, based in Pennsylvania, United States; occasional physical work-site presence required. Travel is less than 25%.

Company

hirify.global provides health insurance and healthcare services focused on supporting member health outcomes and managing care costs.

What you will do

• Manage a caseload of members with complex health needs using advanced clinical knowledge.
• Conduct comprehensive assessments and develop individualized care plans with members, physicians, and healthcare providers.
• Coordinate services and resources, monitor progress, and adjust interventions to support quality and cost-effective outcomes.
• Advocate for members and serve as a liaison across the healthcare team.
• Document activities in accordance with company policies, regulatory requirements, accreditation standards, and HIPAA obligations.
• Provide clinical guidance, mentorship, and problem-solving support to lower-level Case Managers.

Requirements

• At least five years of combined experience in clinical care, case or utilization management, disease condition management, provider operations, or health insurance.
• Current state RN license or current multistate license through the enhanced Nurse Licensure Compact (eNLC).
• Certified Case Manager (CCM) certification must be obtained within 36 months of hire; incumbents in the role as of August 2026 are exempt.
• High school diploma or GED required.
• Expertise in clinical assessment and care planning, with strong negotiation, advocacy, leadership, and mentoring skills.
• Proficiency with Microsoft applications, case management software, and electronic health records.

Nice to have

• Bachelor’s degree in Nursing.
• Specialty clinical experience in areas such as oncology, transplant, maternity, NICU, or pediatrics.
• Experience supporting diverse populations and applying culturally competent care.
• Training in cognitive behavioral therapy, motivational interviewing, or dialectical behavior therapy.
• Certification in a clinical specialty such as OCN, CPN, CPON, CNN, CCTC, or CPHQ.

Culture & Benefits

• Remote or office-based work arrangement.
• Occasional physical work-site presence and less than 25% travel.
• Work is governed by healthcare regulations, accreditation standards, company policies, and HIPAA privacy requirements.
• Commitment to ethical conduct, confidentiality, accessibility, and compliance with applicable laws.