Make clinical decisions that directly impact patient care by ensuring people receive the right treatment at the right time.
About Personify Health
Personify Health is on a mission to simplify and personalize the healthcare experience. We partner with employers, health plans, and health systems to improve outcomes and reduce costs. Our culture is flexible, inclusive, and built around meaningful work that supports wellbeing for every employee.
Schedule
- Part-time
- 100 percent remote
- Flexible hours
- Not eligible for benefits due to part-time status
Responsibilities
- Review treatment requests and determine medical necessity using clinical guidelines
- Evaluate outpatient pre-certifications, inpatient stays (including mental health and substance abuse), skilled nursing, rehab, and post-service reviews
- Collaborate with hospital staff to support safe and appropriate discharge planning
- Refer cases to medical directors for denial authorizations through IRO when required
- Identify and route members to case management, wellness, chronic disease, or Nurturing Together programs
- Process appeals and issue non-certification letters as needed
- Maintain accurate documentation and uphold HIPAA standards
- Meet productivity, quality, and turnaround time expectations
- Apply MCG, internal medical policies, group-specific rules, and NCCN guidelines appropriately
Requirements
- Current RN license (U.S. or U.S. territory)
- Associate’s degree or diploma in Nursing
- 1 year of clinical experience
- Strong clinical judgment across a variety of service lines
- Understanding of medical necessity criteria and utilization review processes
- Ability to redirect providers/patients to PPO network options when appropriate
- Familiarity with documentation systems and electronic health records
- Strong communication and decision-making skills
- Ability to work independently and maintain confidentiality
- Ability to meet yearly training and testing requirements, including IRRA (90 percent minimum)
- Comfort working in a fast-paced, high-volume review environment
Benefits
This is a part-time role and not eligible for benefits.
This position is ideal for a clinically strong RN who enjoys autonomy, evidence-based decision-making, and supporting patients through coordinated and appropriate care pathways.
Happy Hunting,
~Two Chicks…