Case Manager, Nurse, RN

Personify Health

. Contact patients directly and complete thorough assessments covering physical, psychosocial, emotional, spiritual, environmental, and financial needs .

Posted 10/9/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $34 - $36 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management, including the development and monitoring of individualized treatment plans, effective communication with multidisciplinary teams, and proficiency in medical claims processing. Holds a current California RN license and possesses extensive clinical experience in acute care settings.

Highest-signal resume keywords

Registered Nursing (RN) LicenseCase Management ExperienceICD-10, CPT, HCPCS Coding KnowledgeEldorado and UM Web ProficiencyMicrosoft Office Suite Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementClaims ProcessingTreatment Plan DevelopmentUtilization ReviewPatient AssessmentCost ManagementDocumentationCritical Evaluation of Claims DataReferral to Wellness ProgramsMonitoring Treatment Effectiveness

Soft Skills

Emotional SupportGuidanceCommunicationNegotiationCollaboration

Tools & Technologies

EldoradoUM WebClaims Processing Tools

Certifications & Qualifications

California RN LicenseMulti-State RN License

Industry Keywords

Medical Claims ProcessingAcute CareCommunity ResourcesCost AvoidanceHIPAA Compliance

About the role

Key responsibilities & impact

Contact patients directly and complete thorough assessments covering physical, psychosocial, emotional, spiritual, environmental, and financial needs
Use claims processing tools to review paid claim data and identify members needing case management or specific programs
Develop individualized treatment plans for standard and catastrophic cases with patients, caregivers, community resources, and multidisciplinary providers
Set short- and long-term goals
Monitor interventions and evaluate treatment plan effectiveness
Report measurable outcomes
Maintain ongoing contact with patients, families, providers, employers, and the broader care team throughout the continuum of care
Facilitate access to quality care and provide emotional support and guidance
Negotiate and implement cost management approaches
Include cost management impact in monthly case management reviews and cost avoidance reports
Conduct utilization review for assigned members
Evaluate patient needs and make referrals to wellness programs
Maintain complete, confidential documentation in Eldorado and UM Web
Prepare reports at 30-day intervals for high-risk cases and 90-day intervals for low-risk cases according to Company policy and HIPAA
Serve as a clinical resource for LVNs and guide complex case management and clinical decision-making

Requirements

What you’ll need

Graduate of an accredited Registered Nursing (RN) program
Current California RN license required
Multi-state license also required
Minimum of 5 years medical/surgical or acute care experience, including 2 years in case management, or an equivalent combination of education and experience
Prior case management, emergency room, critical care, or other relevant clinical experience pertinent to case management
Knowledge of medical claims processing and ICD-10, CPT, and HCPCS coding
Ability to critically evaluate claims data to inform treatment and discharge planning
Knowledge of community resources and alternate funding programs
Proficiency with Microsoft Office Suite
Working knowledge of case management platforms such as Eldorado and UM Web

Benefits

Comp & perks

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions
Paid Time Off
Mental health support
Retirement planning
Financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact
Wellness programs
Other employee perks
Full benefits package starting day one