Provide telephonic case management to ensure cost-effective, high-quality healthcare for insurance plan participants. Develop and monitor treatment plans while coordinating care between providers, patients, and caregivers.
Personify Health
11 Remote Job Openings at Personify Health
Acts as the primary operational liaison between healthcare providers and the organization's Care Management and Utilization Management programs. Responsibilities include managing provider inquiries, educating staff on authorization workflows, and resolving operational issues to ensure high-quality care.
The Utilization Review Nurse performs professional assessments of treatment requests to determine medical necessity for outpatient and inpatient services. They manage pre-certifications, process appeals, and coordinate with hospital staff to ensure smooth patient transitions to the next level of care.
The Medical Director reviews claims for medical necessity, performs utilization reviews, and issues adverse determinations. They also provide clinical updates to staff and collaborate with leadership to establish departmental work procedures.
Oversee the development and implementation of regulatory compliance, quality assurance, and training programs across Care Management functions. Ensure clinical and non-clinical staff meet state, federal, and accreditation standards while driving continuous quality improvement.
Manager, Implementation Project Management - TPA
Personify Health
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Full Time
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7 days ago
Personify Health
Lead and develop a team of Implementation Project Managers while directly managing complex health plan administration implementations. Drive proactive risk management and coordinate cross-functional alignment to ensure seamless client go-lives and handoffs.
The Process Manager owns a portfolio of cross-functional projects to redesign workflows and reduce operational bottlenecks. They are also responsible for maintaining governance documentation and coordinating communications during system incidents.
The role focuses on coordinating client success through onboarding, performance monitoring, and resolving complex service issues. It involves supporting Account Managers during contract renewals and organizing employee education sessions.
Lead account operations and executive relationships for a high-profile health system partnership, overseeing member services and claims operations. Drive clinical cost containment strategies and deliver data-driven business insights to maximize client ROI and satisfaction.
The Member Services Trainer develops and delivers training programs for new hires and existing staff while maintaining knowledge base content. They also partner with leadership to identify training gaps and measure the effectiveness of learning initiatives against KPIs.
This role involves leading a team of Strategic Account Executives and Account Managers responsible for a portfolio of large clients, focusing on transforming healthcare and wellbeing strategies through consultative partnership. The director will own portfolio performance across retention and revenue growth while coaching the team to deliver results and model exceptional client service.
