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Job Summary:
- Provide telephonic case management between providers, patients and caregivers.
- Ensure cost-effective, high-quality healthcare for health insurance plan participants.
- May be required to work evening and/or weekend shifts.
Essential Functions/Responsibilities/Duties:
- Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs.
- Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner.
- Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care.
Qualifications:
- Graduation from an accredited Registered Nursing (RN) program.
- Possession of a current California RN license; a multi-state license will also be required.
- Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience.
Personify Health
Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. They serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes and have a mission to empower people to lead healthier lives.