RN Medical Case Manager

Location: Remote within the USA; Tennessee RN license required, or an active license in the state of residence if participating in the Nurse Licensure Compact

Company

hirify.global provides health plan and care management services for members with complex healthcare needs.

What you will do

• Manage highly complex cases involving chronic conditions, high-risk diagnoses, behavioral health needs, and home- and community-based care.
• Perform case management activities including assessment, planning, implementation, coordination, monitoring, outcomes evaluation, and follow-up.
• Coordinate care among members, providers, and internal and external stakeholders.
• Support utilization management for complex and non-routine cases and promote efficient use of healthcare benefits.
• Engage members through telephonic and digital channels to improve adherence, health outcomes, and continuity of care.
• Use enterprise-approved digital and AI tools for care delivery, documentation, and operational efficiency.

Requirements

• Active Registered Nurse license in Tennessee or an active license in the state of residence under the Nurse Licensure Compact.
• At least 3 years of clinical experience and 5 years of experience in the healthcare industry.
• Experience in acute care settings such as emergency department, intensive care unit, or medical-surgical care.
• Experience in case management, transitions of care, or discharge planning.
• Strong oral and written communication, critical-thinking, technical, PC, Microsoft Office, and email skills.
• Ability to communicate effectively through telephonic and digital channels; a digital literacy assessment is required.

Culture & Benefits

• Full-time employee position supporting a multidisciplinary, member-centered care model.
• Work is performed remotely through telephonic and digital communication.
• Various immunizations and associated medical tests may be required.
• An 18-month commitment is required before applying for other internal positions.