Case Manager Nurse (Healthcare)

TL;DR

Case Manager Nurse (Healthcare): Providing telephonic case management and patient assessments to ensure cost-effective, high-quality healthcare for insurance plan participants with an accent on clinical assessment, treatment planning, and cost management. Focus on coordinating care between providers and patients, monitoring intervention effectiveness, and conducting utilization reviews.

Location: Remote (United States)

Salary: $36–$37 per hour

Company

hirify.global is a personalized health platform that integrates health plan administration, holistic wellbeing solutions, and comprehensive care navigation.

What you will do

• Conduct thorough telephonic patient assessments covering physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Develop and monitor personalized treatment plans for standard and catastrophic cases in collaboration with patients and providers.
• Coordinate care and maintain continuous communication between patients, families, and multi-disciplinary healthcare teams.
• Advocate for patients to ensure quality care while implementing and negotiating cost-management strategies.
• Perform utilization reviews and maintain detailed clinical documentation in Eldorado and UM Web.
• Serve as a mentor to LVNs and provide guidance on complex clinical cases.

Requirements

• Must be based in the United States.
• Knowledge of medical claims and ICD-10, CPT, and HCPCS coding.
• Experience in discharge planning and the ability to critically evaluate claims data to determine treatment plans.
• Proficiency in Microsoft Office Suite.
• Excellent interpersonal, communication, and negotiation skills.
• Ability to work independently and manage time effectively in a high-productivity environment.

Culture & Benefits

• Competitive base salary and comprehensive medical and dental benefits effective from day one.
• Non-negotiable Paid Time Off (PTO) for rest and recharge.
• Mental health support, retirement planning, and financial protection.
• Professional development opportunities with clear career progression and dedicated learning budgets.
• Mission-driven culture that values diversity, equity, and inclusion.