We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.
Responsibilities
Who are you?
In this role you will wear many hats, but your knowledge will be essential in the following:
Level I
Telephonically manage cases on a long or short term basis per established Company guidelines, policies and procedures, as well as other standardized criteria in the healthcare industry.
Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
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.
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short and long term goals.
Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care.
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information.
Evaluate and make referral for wellness programs.
Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30 day intervals for high risk cases and 90 days interval for low risk cases ensuring confidentiality according to Company policy and HIPAA
Perform Utilization Review for assigned members.
Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues.
Level II
Meet all metrics including productivity and quality on a regular basis with an overall meets to exceeds on yearly evaluation
Demonstrate knowledge by teaching a class, giving presentations in rounds
Ability to review and create care plans and provide oversight on these items for LVN/LPNs
Senior
Has five + years of experience as a case manager
Has attained their CCM or similar certification and maintains while employed by HealthComp
Regular ability to supervise complex cases and educate on how to overcome barriers and help the member
Has negotiation skills
Oversees LPN/LVNs care plans quickly and efficiently
Key Competencies
Level I-II
Knowledge of medical claims and ICD-10, CPT, HCPCS coding.
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.
Computer proficiency or working knowledge of Microsoft Office Suite.
Excellent interpersonal, communication and negotiation skills.
Strong customer orientation.
Good time management skills and highly organized.
Senior
Strong customer orientation skills
Communicates clearly on complex information to outside sources to the company
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Qualifications
What you bring to the Personify Health team:
In Order To Represent The Best Of What We Have To Offer You Come To Us With a Multitude Of Positive Attributes Including
Level I-II
Graduation from an accredited RN program and possession of a current California RN license.
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.
Prefer case management experience, emergent room, critical care background or some other area of clinical care that is pertinent to case management.
Senior
CCM or similar certification
3-5 years direct supervisory role
RN/BSN preferred
Physical And Mental Requirements
Ability to safely and successfully perform the essential job functions with or without a reasonable accommodation, including meeting qualitative and/or quantitative productivity standards.
Ability to maintain regular, punctual attendance.
Ability to sit for 6-8 hours.
Constant use of computer keyboard and mouse; repetitive use of both hands.
Occasional to frequent twisting of neck; occasional bending of neck and at waist.
No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!
Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.
In compliance with all states and cities that require transparency of pay, the compensation for this position ranges from $32.00 to $37.00 per hour. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.
We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.