Complex Case Manager RN (Healthcare)

TL;DR

Complex Case Manager RN (Healthcare): Managing a specified panel of members by assessing health needs and implementing clinical interventions with an accent on care planning and outcome monitoring. Focus on removing barriers to care, coordinating multi-disciplinary resources, and ensuring regulatory compliance.

Location: Remote (Must be based in the US with licensure in PA, WV, DE, or NY)

Company

hirify.global is a leading health insurance and healthcare provider organization.

What you will do

• Perform ongoing assessments of member health needs and identify appropriate clinical interventions.
• Develop and implement comprehensive care plans with long- and short-term goals to improve health outcomes.
• Coordinate with multi-disciplinary teams to refer members to necessary resources and support.
• Monitor and improve clinical, financial, and functional outcomes for the assigned member panel.
• Ensure all activities and documentation comply with CMS, state, and local regulatory requirements.

Requirements

• Current RN licensure in Pennsylvania (PA) or multi-state licensure (eNLC), or licensure in WV, DE, or NY.
• Minimum 7 years of experience in clinical care, case management, or disease/condition management.
• High School Diploma/GED required; Bachelor's Degree in Nursing preferred.
• Proficiency in MS Excel and strong clinical data analytic skills.
• Broad knowledge of disease processes and the healthcare service delivery system.

Nice to have

• Certification in Case Management.
• Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT).
• Experience working with diverse populations and understanding of cultural competency.

Culture & Benefits

• Remote "Working at Home" arrangement.
• Collaborative environment working within a multi-disciplinary team.
• Focus on high-performance and member-centric healthcare outcomes.