RN Case Manager (Healthcare)

TL;DR

RN Case Manager (Healthcare): Managing acute and chronic health conditions for members of the Federal Employees Program with an accent on coordinated care and telephonic engagement. Focus on performing comprehensive assessments, planning interventions, and ensuring efficient utilization of health benefits.

Location: Remote (USA). Must hold an RN license in Tennessee or a participating Compact state.

Company

hirify.global is a major health insurance provider dedicated to improving population health and member outcomes.

What you will do

• Support utilization management functions for complex and non-routine cases.
• Act as a liaison between members, providers, and internal/external customers to coordinate healthcare delivery.
• Oversee high-complexity cases to ensure the effective implementation of interventions and efficient benefit utilization.
• Execute core case management activities: assessment, planning, implementation, coordinating, monitoring, and evaluation.
• Utilize digital channels to communicate effectively and offer technical support to members.

Requirements

• Active Registered Nurse (RN) license in Tennessee or a state participating in the Nurse Licensure Compact Law.
• Minimum 5 years of experience in the healthcare industry.
• Minimum 3 years of clinical experience.
• Certified Case Manager (CCM) credential required or must be obtained within 2 years of hire.
• Sponsorship is not available for this position.
• Ability to pass a digital literacy assessment.

Culture & Benefits

• Fully remote work arrangement.
• Innovation-driven environment incorporating the responsible use of AI-enabled tools to improve member service.
• Commitment to delivering compassionate and seamless member experiences.
• Structured internal growth paths with established workflows and policies.