Complex Case Manager RN (Healthcare)

TL;DR

Complex Case Manager RN (Healthcare): Managing a panel of members with diverse health needs by identifying clinical interventions and developing personalized care plans with an accent on quality outcomes and regulatory compliance. Focus on conducting outreach, removing barriers to care, and coordinating multi-disciplinary resources.

Location: Remote (Must be based in Pennsylvania or hold licensure in PA, WV, DE, or NY)

Company

hirify.global is a leading healthcare organization providing health insurance and clinical services to improve community health.

What you will do

• Perform ongoing health assessments for a specified panel of members to identify clinical interventions and triage to resources.
• Create comprehensive care plans with long- and short-term goals to improve health outcomes.
• Conduct member outreach to encourage behavior changes and address barriers to care.
• Monitor and maintain quality clinical, financial, and functional outcomes for assigned members.
• Ensure all activities are documented in compliance with CMS, state, local, and regulatory agency requirements.

Requirements

• Current State of PA RN licensure OR multi-state licensure (eNLC), WV, DE, or NY.
• 7 years of combined experience in clinical, case management, disease management, or health insurance operations.
• High School Diploma/GED (Bachelor's Degree in Nursing preferred).
• Proficiency in MS Excel and strong ability to interpret and act on clinical and financial data.
• Must be based in Pennsylvania (Working at Home - Pennsylvania).

Nice to have

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

Culture & Benefits

• Remote work arrangement (Working at Home).
• Collaborative environment supported by multi-disciplinary teams.
• Professional growth through ownership of a specific member panel and clinical decision-making.
• Strict adherence to ethical and legal standards through a comprehensive code of business conduct.