Complex Case Manager RN (Medical)

TL;DR

Complex Case Manager RN (Medical): Managing a specified panel of members to identify clinical interventions and develop personalized care plans with an accent on improving clinical, financial, and functional outcomes. Focus on removing barriers to care, coordinating multi-disciplinary resources, and monitoring patient goal achievement.

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

Company

hirify.global is a leading health insurance and healthcare provider focused on delivering integrated care.

What you will do

• Perform ongoing assessments of members' health management needs and identify appropriate clinical interventions.
• Develop comprehensive care plans with short- and long-term goals to improve member health outcomes.
• Coordinate and refer members to multi-disciplinary resources to remove barriers to care.
• Monitor and maintain quality outcomes for the assigned member panel.
• Ensure all activities are documented in compliance with CMS, state, and regulatory agency standards.

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.
• High School Diploma/GED required.
• Proficiency in MS Excel and strong analytic skills for interpreting clinical and financial data.
• Ability to work autonomously and handle multiple priorities in a fast-paced environment.

Nice to have

• Bachelor's Degree in Nursing.
• Certification in Case Management.
• Advanced training in CBT, motivational interviewing, or DBT.
• Experience working with diverse populations and understanding of cultural competency.

Culture & Benefits

• Flexible work arrangements including "Working at Home" options within Pennsylvania.
• Collaborative environment with a multi-disciplinary team support system.
• Commitment to high ethical and legal standards of business conduct.