Complex Case Manager RN (Medical)

TL;DR

Complex Case Manager RN (Medical): Managing a panel of members with varying health statuses and clinical needs with an accent on assessment, care plan development, and clinical intervention. Focus on improving health outcomes, coordinating multi-disciplinary resources, and ensuring compliance with regulatory standards.

Location: Must be based in Pennsylvania or hold a valid multi-state RN license (eNLC, WV, DE, or NY)

Company

hirify.global is a large healthcare organization providing health insurance and provider services.

What you will do

• Maintain oversight of a member panel by assessing health management needs and identifying appropriate clinical interventions.
• Create and manage comprehensive care plans with both short and long-term goals for enrolled members.
• Conduct member outreach to address barriers to care, encourage behavior changes, and coordinate necessary resources.
• Monitor and improve clinical, financial, and functional outcomes for assigned members.
• Document all activities in compliance with business processes, regulatory requirements, and accreditation standards.
• Collaborate with multi-disciplinary teams to ensure members receive appropriate support and resources.

Requirements

• Current State of PA RN licensure or multi-state licensure (eNLC, WV, DE, or NY) required.
• Bachelor's Degree in Nursing.
• 7 years of experience in clinical, case management, disease management, or health insurance operations.
• Proficiency in MS Excel and ability to interpret clinical and financial data.
• Strong interpersonal, negotiation, and influencing skills.
• Ability to work independently with indirect supervision in a fast-paced environment.

Nice to have

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

Culture & Benefits

• Opportunity to work in a high-performing, collaborative team environment.
• Focus on professional growth and adherence to high ethical and legal standards.
• Commitment to accessibility and non-discrimination in the workplace.