Telephonically coordinate wellness and disease management for members with chronic conditions using nationally recognized care guidelines. Develop individualized care plans, facilitate referrals, and maintain accurate documentation while meeting productivity and quality standards.
Because health is personal. That's why 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. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com.
Ready to (Please Note: All Candidates MUST possess an active Compact Licensure and be available to work within the Pacific Timezone) What You'll Actually Do ESSENTIAL DUTIES and RESPONSIBILITIES: Telephonically coordinate wellness and disease management for members with chronic conditions, including but not limited to diabetes, asthma, COPD, CAD, CHF, atrial fibrillation, hypertension, and hyperlipidemia. Proactively contact targeted members to promote health and restore optimal functioning by applying nationally recognized care guidelines and comparing current care with industry standards. Review gaps in care and medical and pharmacy paid claims data to develop a comprehensive clinical profile; create individualized care plans and provide close follow-up for actively managed patients. Collaborate with members to ensure assignment to a primary care provider; facilitate referrals to specialists as needed; assist with obtaining durable medical equipment and reviewing pricing for high-cost medications. Support the Utilization Review process for assigned members in accordance with organizational and regulatory standards. Assess member needs and initiate referrals to case management, prenatal, wellness programs, and external vendor services as appropriate. Maintain complete, accurate, and timely documentation of case-managed members in designated systems; document all interventions and patient contacts while ensuring confidentiality and privacy of member records. Track and monitor moderate and high-risk member populations and associated interventions to demonstrate improvements in overall health outcomes. Meet established productivity, quality, and turnaround time standards on a daily, weekly, monthly basis. Successfully participate in and pass external audits, including NCQA and URAC. Maintain HIPAA compliance and confidentiality requirements in accordance with company policies and procedures. Complete all required annual training within designated timeframes. KEY COMPETENCIES: To be successful in a remote healthcare environment, individuals must demonstrate strong technical aptitude, communication skills, and the ability to work independently. Upon Hire, must have: Basic computer literacy with the ability to navigate multiple systems simultaneously. Ability to work on multiple screens with proficient typing skills. Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Microsoft Outlook. Strong verbal and written communication skills, including the ability to clearly explain complex or technical information and accurately interpret information received from others. Ability to work independently, manage time effectively, utilize written resources to problem-solve and make informed decisions. Foundational knowledge of medical claims processing and medical terminology, including ICD10, CPT, and HCPCS coding. Post-Training Expectations: After completion of initial training and a structured ramp period (approximately three [3] months total), demonstrate proficiency in required systems and tools. Ability to quickly adapt to additional systems or tools as job responsibilities evolve.
Qualifications: What You Bring to Our Team
Graduate of an accredited Registered Nurse (RN) program with a current, unrestricted Registered Nurse license issued in the United States. The organization may require additional state licensure(s) to meet operational and business needs. California, Washington and Oregon Licenses required after hire Prior experience in case management, wellness or disease management coordination, or an equivalent combination of education, clinical training, and relevant professional experience. Demonstrated ability to apply clinical knowledge in a managed care, population health, or remote healthcare environment. Bilingual English/Spanish preferred Willingness to travel Physical and Mental Requirements: Ability to perform the essential functions of the position safely and effectively, with or without reasonable accommodation, including meeting established qualitative and/or quantitative productivity standards. Ability to maintain regular, punctual attendance in accordance with organizational policies. Ability to remain seated for extended periods of time (approximately six [6] to eight [8] hours per workday). Continuous use of a computer workstation, including frequent keyboarding and mouse usage, requiring repetitive hand and finger movements. Ability to perform frequent neck twisting and occasional bending of the neck and waist as required to perform job duties. This job description is not an exclusive or exhaustive list of all job functions that an employee in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced, or delegated by management to meet the business needs of MedCom a Personify Health Company.
The Highlights: Competitive base salary and benefits effective day one Comprehensive medical and dental through our own health solutions (yes, we use what we build) Paid Time Off—rest and recharge time is non-negotiable Mental health support, retirement planning, and financial protection Professional development with clear career progression and learning budgets Mission-driven culture where diverse perspectives drive real impact on people's health Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks.
This position offers a base salary range of $31-$38 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one.
Our
Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.
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Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View all legitimate openings at personifyhealth.com/careers.
Must be a graduate of an accredited RN program with an active Compact Licensure and be available to work in the Pacific Timezone. Requires prior experience in case or disease management and proficiency in basic computer applications.