Lead Disease Management - RN

Personify Health

2d • $38 - $40

About The Position

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.
Job Summary
Provide daily direction and communication to case management staff through motivation, coaching, counseling, training, quality control review and problem-solving. Coordinate care and services and develop patient treatment plans for catastrophic cases. Will also provide treatment plans and supervise all LVN work. Must be available to work Monday- Friday 8am-5pm and occasional Saturday (if needed)
What You'll Actually Do
Essential Functions/Responsibilities/Duties
Provide daily leadership, direction, and communication to Chronic Disease Management (CDM) staff through motivation, coaching, counseling, training, quality review, and problem-solving.
Collaborate with management to establish and maintain workflows, procedures, and processes that align with company standards, departmental goals, and strategic initiatives.
Exercise sound judgment in escalating department-level or employee-related concerns through appropriate leadership channels.
Monitor, audit, and analyze staff performance; identify performance gaps; develop and implement corrective action plans; and support ongoing system and process improvements.
Plan, organize, and distribute work assignments; communicate policy and procedural updates; instruct staff on approved methods; and resolve complex or non-routine operational issues.
Train and mentor staff on managing patient cases telephonically on a short- or long-term basis in accordance with company guidelines, policies, procedures, and recognized healthcare standards.
Train and mentor staff on patient outreach and comprehensive assessments, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
Train staff on developing individualized care plans in collaboration with patients, caregivers, families, community resources, and multidisciplinary healthcare providers, incorporating achievable short- and long-term goals.
Train staff on monitoring interventions, evaluating treatment plan effectiveness, and documenting measurable outcomes to demonstrate intervention success.
Guide staff in patient advocacy by facilitating high-quality care delivery, supporting cost-effective outcomes, and providing emotional support and education to patients and families.
Ensure staff meet established productivity, quality, and daily performance metrics.
Maintain readiness for and successfully pass external audits, including URAC and NCQA.
Ensure compliance with HIPAA regulations, company policies, confidentiality standards, and minimum necessary requirements.
Complete all required annual training within established company timelines.
Willingness to travel
Occasional travel required (approx. 1-3 time per year)

Requirements

• RN California Licensure required.
• Minimum of five 3-5 years medical/surgical or acute care experience, including prior supervisory experience, or an equivalent combination of education and experience.
• Basic computer literacy, including proficiency with keyboarding and navigating multiple screens simultaneously.
• Proficient typing skills.
• Proficiency in common business software applications, including Microsoft Word, Microsoft Excel, and Outlook.
• Strong verbal and written communication skills.
• Ability to clearly articulate complex or technical information and accurately interpret information provided by others.
• Ability to work independently and utilize written resources, policies, and procedures to resolve issues and solve problems.
• Working knowledge of medical claims processes and medical coding systems, including ICD-10, CPT, and HCPCS.
• Microsoft Teams (on- and off-camera), SharePoint, VPN access tools, UM Web, Health Notes, ADP, Confluence, MyCare, Phone systems utilizing a headset, Smartsheet, (Additional applications may be required based on specific job responsibilities.)
• Ability to communicate effectively with leadership and team members, supporting both upward and downward communication.

Nice To Haves

• 2 plus years’ experience in case management preferred.

Responsibilities

• Provide daily leadership, direction, and communication to Chronic Disease Management (CDM) staff through motivation, coaching, counseling, training, quality review, and problem-solving.
• Collaborate with management to establish and maintain workflows, procedures, and processes that align with company standards, departmental goals, and strategic initiatives.
• Exercise sound judgment in escalating department-level or employee-related concerns through appropriate leadership channels.
• Monitor, audit, and analyze staff performance; identify performance gaps; develop and implement corrective action plans; and support ongoing system and process improvements.
• Plan, organize, and distribute work assignments; communicate policy and procedural updates; instruct staff on approved methods; and resolve complex or non-routine operational issues.
• Train and mentor staff on managing patient cases telephonically on a short- or long-term basis in accordance with company guidelines, policies, procedures, and recognized healthcare standards.
• Train and mentor staff on patient outreach and comprehensive assessments, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Train staff on developing individualized care plans in collaboration with patients, caregivers, families, community resources, and multidisciplinary healthcare providers, incorporating achievable short- and long-term goals.
• Train staff on monitoring interventions, evaluating treatment plan effectiveness, and documenting measurable outcomes to demonstrate intervention success.
• Guide staff in patient advocacy by facilitating high-quality care delivery, supporting cost-effective outcomes, and providing emotional support and education to patients and families.
• Ensure staff meet established productivity, quality, and daily performance metrics.
• Maintain readiness for and successfully pass external audits, including URAC and NCQA.
• Ensure compliance with HIPAA regulations, company policies, confidentiality standards, and minimum necessary requirements.
• Complete all required annual training within established company timelines.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed