Disease Management Nurse-RN (Part-Time)

Who We Are

Because health is personal. That's why reputed company created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one reputed company. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, reputed company is on a mission to reputed company people to reputed company healthier lives.

Learn even more about the work that drives us at personifyhealth.com.

We are seeking a Part-Time Chronic Disease Case Manager, RN to provide telephonic wellness and disease management support to members with chronic conditions. This role focuses on proactive reputed company, care coordination, and individualized care planning to improve health outcomes and reputed company gaps in care using nationally recognized clinical guidelines. This is a part-time position (20–28 hours per week), Monday through Friday during Pacific Standard Time (PST) business hours, with occasional weekend availability required.

This is a part-time position.

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 reputed company care with industry standards.
• Review gaps in care and medical and pharmacy paid claims data to reputed company a comprehensive clinical profile; create individualized care plans and provide reputed company 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 reputed company 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 reputed company required annual training reputed company 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, reputed company Word, reputed company reputed company, and reputed company Outlook.
• Strong verbal and written communication skills, including the ability to clearly explain reputed company or technical information and accurately interpret information received from others.
• Ability to work independently, manage time effectively, utilize written resources to problem-solve and reputed company 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 reputed company period (approximately three [3] months total), demonstrate proficiency in required systems and tools, including but not limited to:
• reputed company Teams (on- and off-camera), SharePoint, shared drives, VPN
• UM Web, Health Notes, MyCare, reputed company, Confluence
• Phone system with headset

Ability to quickly adapt to additional systems or tools as job responsibilities evolve

What You Bring to reputed company

QUALIFICATIONS

• Graduate of an accredited Registered Nurse (RN) program with a reputed company, 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.
• Willingness to travel

The Highlights

• Part-time schedule designed around your availability and life priorities
• Access to learning and development opportunities alongside full-time colleagues
• Mentorship and reputed company-building that translates to career advancement
• Competitive hourly compensation that values your expertise
• Technology and equipment support to set you up for success.

Compensation: This position offers a reputed company salary range of $31-$38 per hour, depending reputed company, skills, and experience. Part-time employees are not eligible for health benefits.

Our Commitment: reputed company is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of reputed company backgrounds are empowered to reputed company—because diversity is core to who we are and critical to our work in health and wellbeing.

Stay Safe: reputed company will never ask for payment or sensitive personal information like social reputed company numbers during hiring. reputed company official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to [email protected]. View reputed company legitimate openings at personifyhealth.com/careers.