RN - LTSS Case Management Liaison (Hybrid - APX 75% Remote)

Location: Must live in Massachusetts; hybrid schedule with approximately 75% remote work and 25% in-person meetings, training, and backup support. Occasional direct member interaction may be required.

Expected salary range: $100,000–$105,000 annually.

Company

hirify.global provides care and support services for complex and underserved member populations.

What you will do

• Review assessments, visit notes, medication records, and external care documentation to determine members’ functional status and LTSS needs.
• Produce clinical determinations and written rationales for initial requests and annual redeterminations under applicable contracts and state regulations.
• Submit determinations to health plan Utilization Management teams and manage clinical information exchange through resolution.
• Manage appeals end to end, verify member input, prepare complete appeal packets, track deadlines, and develop clinical materials for Board of Hearings proceedings.
• Prioritize daily review queues, identify documentation gaps and capacity constraints, and maintain turnaround standards.
• Coordinate with market care teams, external LTSS agencies, health plan clinicians, Compliance, and clinical leadership while maintaining audit-ready records in Commons and Athena.

Requirements

• Active, unrestricted Massachusetts RN or NP license in good standing is required at the time of hire.
• Graduate of an accredited school of nursing.
• At least 3 years of clinical experience; utilization management, clinical review, or medical necessity determination experience is strongly preferred.
• Working familiarity with LTSS, including home and community-based services, personal care, adult day health, home health, and durable medical equipment.
• Understanding of MassHealth LTSS criteria and Medicaid and Medicare Advantage authorization, appeals, grievances, Board of Hearings procedures, and continuation of services during appeals.
• Experience with dually eligible, medically complex, or behavioral health populations; proficiency with Commons, Athena, and TalkDesk.

Nice to have

• Additional state licensure or multistate compact privileges.
• Experience with MDS-HC, MDS, or equivalent functional assessment instruments.
• Proficiency in multiple languages.

Culture & Benefits

• Hybrid work arrangement with most work performed remotely.
• Health insurance, life insurance, and retirement benefits.
• Participation in the company equity program.
• Paid vacation and sick leave.
• Work involving collaboration with care teams, health plan clinicians, external service agencies, Quality, and Compliance.