Personify Health

Compensation

Full Description

Description: • Provide telephonic case management and patient education for members with severe or chronic conditions • Coordinate care and services and develop patient treatment plans for catastrophic cases • Telephonically manage cases long or short-term per company guidelines and industry criteria • Contact patients and complete thorough assessments (physical, psychosocial, emotional, spiritual, environmental, financial) • Develop treatment plans in collaboration with patients, caregivers, community resources and multidisciplinary providers • Monitor interventions, evaluate effectiveness, and report measurable outcomes • Initiate and maintain contact with patients/families, providers, employer groups, and multidisciplinary teams • Advocate for patients to facilitate quality care and reduce costs; provide emotional support and guidance • Meet daily productivity requirements • Negotiate and implement cost management strategies and report cost avoidance • Perform data entry and maintain complete documentation; maintain confidentiality according to HIPAA Requirements: • Current unrestricted RN license • California license (preferred) • 1+ years of case management experience required • Computer proficiency and working knowledge of Microsoft Office Suite and Microsoft Outlook • Knowledge of medical claims and ICD-10, CPT, HCPCS coding preferred • Knowledge of utilization management/quality management case philosophies and reporting requirements; quality improvement methodologies preferred • Ability to critically evaluate claims data and determine treatment plan; discharge planning experience • Ability to work independently making decisions and problem solving • Knowledge of community resources and alternate funding programs • Excellent interpersonal, communication and negotiation skills • Strong customer orientation • Good time management skills and highly organized Benefits: • Total rewards, flexible opportunities, and a diverse inclusive community • Eligible for health benefits • Dental • Vision • Mental health benefits • Other benefits