• Job Description

  Req#: 4407

  Overview

  Who We Are

  Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. 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

  We are seeking a Case Manager Nurse LVN/LPN who will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants.

  What You'll Actually Do

  • Manage cases on a short- and long-term basis over the phone
  • Administer basic questionnaires and assessments to determine a patient’s diagnosis, treatments, barriers to care, and healthcare needs
  • Collaborate with RN Case Manager to create and implement individualized plans
  • Educate patients on treatment and services options, navigating their health plan, benefits utilization, coordinating referrals, etc.
  • Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care
  • Monitor interventions, evaluate the effectiveness of the treatment plan, report measurable outcomes
  • Establish working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance, and information
  • 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
  • Ability to meet productivity, quality, and turnaround time requirements on a daily, weekly, and monthly basis

  Qualifications

  What You Bring to Our Mission

  • Graduation from an accredited LVN/LPN program and a current LVN/LPN license
  • Prior experience in case management, coordinating wellness programs, or an equivalent combination of education and experience.
  • Experience in medical, surgical, and/or acute care setting
  • Strong understanding of how to manage cases and coordinate health programs
  • Clear communication style and strong collaboration skills
  • Computer proficiency and working knowledge of Microsoft Office Suite and Microsoft Outlook required.
  • Knowledge of medical claims and ICD-10, CPT, HCPCS coding preferred.
  • Knowledge of utilization management/quality management case philosophies and reporting requirements; quality improvement methodologies preferred.
  • Ability to critically evaluate claims data and provide accurate patient assessment; ability to establish nursing treatment plans.
  • Excellent interpersonal and communication skills; strong customer orientation; good time management skills; highly organized.

  Why You'll Love It Here

  We believe in total rewards that actually matter—not just competitive packages, but benefits that support how you want to live and work.

  Your wellbeing comes first:

  • Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!)
  • Mental health support and wellness programs designed by experts who get it
  • Flexible work arrangements that fit your life, not the other way around

  Financial security that makes sense:

  • Retirement planning support to help you build real wealth for the future
  • Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
  • Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage

  Growth without limits:

  • Professional development opportunities and clear career progression paths
  • Mentorship from industry leaders who want to see you succeed
  • Learning budget to invest in skills that matter to your future

  A culture that energizes:

  • People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation
  • One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges
  • We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results
  • Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable

  The practical stuff:

  • Competitive base salary that rewards your success
  • PTO policy because rest and recharge time is non-negotiable
  • Benefits effective day one—because you shouldn’t have to wait to be taken care of

  Ready to create a healthier world? We're ready for you.

  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 $26 to $28 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.

  #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.

• About the company

  See how Virgin Pulse's employee well-being solution helps employees create habits that matter so they can be their best at work and at home.

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