Now is the time to join us! 

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.

Who are you?

Responsible for the overall clinical aspects of the Care Management Team.

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Supervise Utilization Management Review (UM) Chronic Disease Management (DM) and Case Management(CM) team personnel including participating in interviewing, hiring, and training employees; plan, assign, and direct work; appraise performance; rewarding and disciplining employees; addressing complaints and resolving problems.
• Keep team informed of clinical updates including compliance state, federal and local requirements.
• Work in conjunction with the VP of Care management to establish work procedures and processes that support company and departmental standards, procedures, and strategic directives.
• Use appropriate judgment in upward communication regarding department or employee concerns.
• Maintain and improve UM DM and CM teams operations by monitoring system performance; identify and resolve problems; audit and analyze staff performance; prepare and complete action plans; assist in managing system and process improvement and quality assurance programs as it relates to clinical management and plan language interpretation.
• Oversee the negotiation and implementation of cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews as it relates to clinical aspects.

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.

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:

• Associate Degree of Nursing plus 3 years mgt. experience or Bachelor Degree of Nursing RN

   

• Licensure as a registered Nurse. May require other state licensure.

   

• Masters Degree of Nursing preferred

   

• Certification in Case Management or Utilization Review a plus.

   

• Minimum 5 years of Utilization Management, Case Management, Chronic Disease Management and/or Hospital experience required.

   

• Minimum 3 years of compliance related experience preferred.

   

• Managed Care management experience preferred in UR, CM, and/or DM

   

• Strong written, verbal and presentation communication skills

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• Microsoft Office and other computer skills including learning, guiding and building software programs with IT team

• Flexible and able to prioritize day-to-day position requirements

• Strategic thinking with proven ability to communicate a vision and drive results

• Proficient in analysis and interpretation of clinical data and the ability to communicate information out to groups, brokers and leadership teams

• Comfortable with multiple accountabilities and matrix management

• Proven record of strong relationships and working with diverse teams

• Demonstrated ability to work independently with excellent judgment

• Strong interpersonal skills necessary to effectively communicate with medical personnel and members

• Analytical and problem solving skills necessary to identify and review pertinent information

• The ability to incorporate analytical data into new or existing clinical programs to enhance quality of care

• Ability to maintain a very high level of confidentiality

• Able to successfully handle competing priorities

• Experience in the Utilization Review Process which includes Prior-Authorization/Pre-Certification, Retro Reviews, Concurrent Reviews, Appeals and Post Service Claims Review

• Experience in disease management and know and understand disease progression

• Knowledgeable of the Federal, State and ERISA regulations

   

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 base compensation for this position ranges from $118,560 to $137,000. Note that salary may vary based on location, skills, and experience. This position is eligible for 10% target bonus/variable compensation as well as 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.

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#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@personifyhealth.com. All of our legitimate openings can be found on the Personify Health Career Site.

Application Deadline: Open until position is filled.