Case Manager Nurse-RN (Part-Time)

TL;DR

Case Manager Nurse-RN (Part-Time): Telephonic case management between providers, patients, and caregivers to ensure cost-effective, high-quality healthcare for health plan participants with an accent on claims-based clinical assessment, treatment plan development, and utilization review. Focus on monitoring interventions, documenting outcomes and case notes in Eldorado and UM Web, and coordinating care across multidisciplinary teams while meeting productivity, quality, and turnaround time requirements.

Location: Remote, United States

Salary: $36–$38 per hour

Company

hirify.global provides a personalized health platform that combines health plan administration, wellbeing solutions, and care navigation.

What you will do

• Contact patients and complete thorough assessments across physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Review and research paid claim data using claims processing tools to build a clinical picture and identify appropriate programs.
• Develop and update treatment plans for standard and catastrophic cases with obtainable short- and long-term goals.
• Monitor interventions, evaluate effectiveness, and report measurable outcomes; prepare cost avoidance and case management review reporting.
• Maintain ongoing contact across the continuum of care with patients/families, providers, employers, and multidisciplinary teams.
• Perform utilization review and maintain complete, detailed, confidential documentation in Eldorado and UM Web (including 30-day updates for high-risk and 90-day intervals for low-risk cases).

Requirements

• Graduation from an accredited Registered Nursing (RN) program.
• Current California RN license; a multi-state license will also be required.
• Minimum 5 years medical/surgical or acute care experience, including 2 years of case management experience (or an equivalent combination of education and experience).
• Knowledge of medical claims and ICD-10, CPT, and HCPCS coding; ability to critically evaluate claims data for treatment planning and discharge planning.
• Ability to work independently with strong problem-solving and decision-making.
• Computer proficiency (Microsoft Office Suite) and strong interpersonal, communication, and negotiation skills.

Culture & Benefits

• Part-time schedule designed around availability and life priorities.
• Access to learning and development opportunities alongside full-time colleagues.
• Mentorship and skill-building to support career advancement.
• Technology and equipment support to set you up for success.
• Part-time employees are not eligible for health benefits.