Care Management Specialist II

Location: Telecommuter; hiring is limited to listed U.S. states: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, and Wisconsin.

Salary: $48,400–$72,600 national range; $55,200–$82,800 national plus range for higher-cost labor markets, including Western Washington and Alaska.

Company

hirify.global is a healthcare organization focused on improving customers’ lives through better healthcare services.

What you will do

• Process inpatient and outpatient service requests submitted by fax and electronically.
• Use Facets, Jiva, and Appian to manage notifications, discharges, pre-service requests, and outpatient services.
• Support customer service representatives with unresolved medical inquiries and consult clinical staff when appropriate.
• Apply scripted clinical criteria and medical terminology to collect data, conduct initial case screening, and process requests without clinical interpretation.
• Handle specialized and complex account needs, including customized benefits and overlapping coverage issues.
• Identify system and provider trends, recommend process changes, lead improvement initiatives, and support training for new team members.

Requirements

• High school diploma or GED.
• At least one year of experience in a customer service-oriented environment.
• Effective written, verbal, and telephone communication skills.
• Strong time management, organization, prioritization, and follow-through skills in a high-production environment.
• Ability to work independently, collaborate with a team, and work flexible hours.
• Intermediate Microsoft Office skills, familiarity with Excel, and basic medical terminology knowledge.

Nice to have

• Associate degree in a medically related field.
• One year of experience with Premera systems and tools.

Culture & Benefits

• Permanent weekend schedule requiring regular work on both Saturdays and Sundays after training and ramp-up.
• Medical, vision, and dental coverage with low employee premiums.
• Life and disability insurance, retirement programs with a 401(k) match, and a pension plan vested after three years.
• Paid time off, wellness resources, counseling and stress management programs.
• Tuition assistance for undergraduate and graduate degrees.
• Employee recognition programs and additional voluntary benefits, including pet insurance.