Case Manager RN (Remote)

Location: Remote, working from home in Pennsylvania

Company

hirify.global is the employing organization for this healthcare case management position.

What you will do

• Manage a caseload of members with moderate-complexity health needs.
• Assess member health status, needs, resources, and eligibility for appropriate services.
• Develop, implement, coordinate, and monitor individualized care plans with members, physicians, and healthcare providers.
• Coordinate specialist referrals and connections to community resources.
• Evaluate progress and intervention effectiveness, adjusting care plans as needed.
• Identify opportunities for cost savings, quality improvement, workflow efficiency, and prevention of improper benefit utilization.

Requirements

• High school diploma or GED.
• At least 3 years of combined experience in clinical care, case or utilization management, disease condition management, provider operations, or health insurance.
• Current Pennsylvania RN licensure, or multi-state licensure through the enhanced Nurse Licensure Compact; licensure in West Virginia, Delaware, or New York is also accepted.
• Strong assessment and care planning skills, with the ability to work independently and collaboratively.
• Proficiency with Microsoft Office, case management software, and electronic health records.
• Understanding of healthcare systems and case management principles.

Nice to have

• Bachelor's degree in Nursing.
• Utilization management or registered nurse case management experience.
• Experience supporting diverse populations and applying cultural competency.

Culture & Benefits

• Remote position with no physical work-site attendance required.
• Travel requirement of 0%–25%.
• Work includes collaboration with physicians, providers, coworkers, and other healthcare professionals.
• Responsibilities follow applicable regulatory requirements, accreditation standards, HIPAA, privacy policies, and information security guidelines.