Vytalize Health

Role Description The RN Case Manager works with the clinical department and acts as a liaison with our physician practices. The RN Case Manager advocates for personalized treatment options that address a patient’s unique care needs. The RN Case Manager has a patient-forward approach that is centered in the value-based care model, offers education and guidance for navigating complex medical decisions, and creates and manages the plan of care for patients with chronic or serious conditions. You will be responsible for using your assessment and communication skills to engage with patients in need of clinical support to determine and prioritize their needs. You will deliver patient-centered care, provide exceptional customer service, and work within your scope of practice to provide evidence-based education, assessment, and care navigation. - Identify patient/caregiver education needs through telephonic assessment/engagement and ensure that the patient/caregiver has adequate information to participate in the successful transition back to their home setting from an inpatient or post-acute facility stay. - Conduct timely telephonic clinical outreach to identified patients. - Collaborate with PCPs, NPs, and other members of the healthcare team to coordinate care for patients and actively help keep them stable at home. - Serve as the point of contact and informational resource for patients, care teams, family/caregivers, payers, and community resources. - Implement interventions that improve health outcomes, lower costs, and enhance the patient experience. - Work collaboratively with provider offices, SNFs, hospitals, and other Clinical Services teams to support each patient’s needs efficiently and effectively. - Assist in coordination across the continuum of care while maintaining confidentiality. - Guide patients through the healthcare system and help them overcome barriers. - Coordinate treatment and services for patients. - Schedule medical appointments as needed. - Communicate about a patient’s health condition with the patient and their family. - Provide community resources to patients as needed and support resolution of SDoH. - Maintain a comprehensive working knowledge of community resources. - Assume accountability for the quality of care. - Continually seek new knowledge and learning that supports clinical care coordination. - Depending on market location, minimal travel may be required to visit provider offices to help enhance provider office engagement (less than 5%). Qualifications - Must be located in the Kansas City, MO region preferably, or reside in Kansas. - Bachelor’s degree in Nursing preferred, or Associate’s degree in Nursing with relevant experience. - 5 years’ experience as an RN or RN Case Manager providing complex care management. - Minimum of 3 years’ experience in Med Surg or Home Health. - Experience providing Transitions of Care. - Startup experience preferred. - Unencumbered RN license, compact nursing license, or compact nursing license obtained within 6 months of hire. - Accredited Case Manager (ACM) preferred. - Comfortable and able to adapt to rapid changes. - Excellent verbal and written communication skills. - Excellent organizational skills and attention to detail. - Entrepreneurial spirit, with a sense of ownership and comfort operating in ambiguity. - Solution-oriented with the ability to think strategically and creatively in decision-making. - Able to work independently and engage as part of a fully remote team. - Coachable and able to take direction and feedback well, while also being forward-thinking to challenge the status quo. - Comfortable providing care management using telehealth capabilities. - Proficient with Microsoft Office Suite or related software. - Ability to effectively and efficiently use various documentation tools and technological platforms, including EMRs; comfortable with digital technologies. - Demonstrates a positive attitude and respectful, professional customer service. Benefits - Competitive base compensation. - Annual bonus potential. - Health benefits effective on start date. - Health & Wellness Program: up to $300 per quarter for your overall well-being, available on start date. - 401(k) plan effective the first of the month after your start date; 100% match of up to 4% of your annual salary. - Unlimited (or generous) paid “Vytal Time,” and 5 paid sick days after your first 90 days. - Company-paid STD/LTD. - Technology setup. - Opportunity to help build a market leader in value-based healthcare at a rapidly growing organization. Disclaimer Please Note: At no time during our screening, interview, or selection process do we ask for additional personal information (beyond your résumé) or account/financial information. We will also never ask you to purchase anything, nor will we ever interview you via text message. Any communication received from a Vytalize Health recruiter during your screening, interviewing, or selection process will come from an email ending in @vytalizehealth.com.

• Responsible for the design, implementation, and operational execution of secure development, cloud, and endpoint security practices • Embeds information security controls directly into engineering and IT workflows • Focus on vulnerability management, security baselines, threat modeling, and secure architecture • Leverages AI capabilities, including AWS AI services and Claude to standardize, streamline, and scale security operations • Design and implement secure architecture patterns across applications, CI/CD pipelines, and cloud platforms • Conduct threat modeling and security design reviews for new systems and major changes • Lead vulnerability management across GitHub, AWS Inspector, Microsoft Defender, and CrowdStrike Falcon • Ensure vulnerabilities are triaged, tracked, and remediated within defined SLAs • Design and enforce AWS security baselines including VPCs, security groups, and perimeter controls • Identify and remediate unintended network exposure • Apply AWS AI services and Claude to standardize vulnerability analysis, remediation workflows, and reporting • Ensure AI usage is auditable, explainable, and secure • Develop and maintain security baselines aligned to NIST CSF, SOC 2, and HIPAA where applicable • Produce audit-ready documentation and metrics • Partner with Engineering and IT teams to integrate security into delivery processes • Communicate security risks and remediation status to Information Security leadership

• Train, coach, and mentor Market Medical Directors to expand their influence and engagement with primary care practices. • Exercise supervisory responsibility and ultimate accountability for pod performance, ensuring clinical and financial success. • Meet regularly with Market Medical Directors to troubleshoot practice challenges, provide strategic guidance, and offer ongoing support. • Provide guidance and keep Market Medical Directors abreast of Regulatory and Compliance issues as they pertain to CMS regulations and ACO contractual obligations. • Regularly review key performance indicators and clinical utilization metrics delivered by Market Medical Directors, highlighting areas that require focus or additional motivation. • Ensure productivity targets are met related to practice meetings, pod meetings, and internal assignments. • Identify opportunities to improve practice workflows, healthcare utilization, and clinical documentation accuracy. • Drive continuous performance improvements by analyzing data trends and implementing strategic interventions at a regional level. • Work with Market Medical Directors to ensure ACO practice compliance with Vytal Signs gates including but not limited to EMR access, EMR integration, use of Vytalize VBC tools, and participation in clinical programs. • Work collaboratively across departments, including Regional Vice Presidents, Practice Transformation Managers, Risk & Quality Teams, and Product & Tech Teams, to align on value-based care strategies and clinical initiatives. • Assess areas of greatest opportunity within ACO practices, identifying potential changes, enhancements, or new programs to optimize healthcare delivery. • Promote value-based clinical strategy by supporting Vytalize Health's initiatives and lending clinical perspective to strategic discussions, including selection and prioritization of organization-wide initiatives. • Provide clinical oversight for ongoing initiatives, shaping new strategies that align with evolving healthcare models and provider needs. • Spread best practices across pods, sponsoring provider collaboration and knowledge-sharing sessions, particularly through pod meetings. • Develop, refine, and propagate key initiatives, enabling Market Medical Directors to focus on direct physician engagement. • Periodically present clinically (virtually or in person) to practices, reinforcing VBC principles and supporting PCP engagement. • Collaborate across Vytalize’s Central and Market Medical Directors to share achievements, refine strategies, and seek advice and feedback. • Engage in ACO leadership meetings, contributing insights to refine national and regional healthcare initiatives. • Attend and participate in Vytalize Physician Advisory Council meetings.

• Design and implement security mechanisms to protect Vytalize data and information systems. • Assess risks and design information system security architecture. • Perform regular control assessments to identify control deficiencies. • Coordinate security risk assessments across the ecosystem, audits, or information security program certifications. • Conduct third-party information security risk assessments. • Respond to and manage information security events.

• Review medical record documentation and claim information prior to submission to ensure accurate assignment of ICD-10-CM, CPT, and HCPCS codes, supporting appropriate reimbursement and compliance with regulatory requirements. • Review and analyze coding-related claim denials, underpayments, and payer audit findings to identify root causes and recommend corrective actions that improve reimbursement outcomes. • Research payer policies, coding guidelines, and medical record documentation to support denial appeals, claim corrections, and reconsideration requests when appropriate. • Collaborate with billing and operational teams to resolve coding-related claim issues, reduce recurring denials, and improve first-pass claim acceptance rates. • Monitor coding, billing, and denial trends; prepare reports and collaborate with leadership and operational teams to implement process improvements, coding edits, and workflow enhancements that support compliance and reimbursement optimization. • Stay current on changes to coding regulations, reimbursement methodologies, payer policies, and industry best practices through ongoing education and professional development.

• The Epic Resolute Analyst develops, implements, and supports Epic Resolute Professional Billing. • Interacts directly with operations and the clinical applications team to analyze and specify application requirements and workflows and to make system recommendations. • Assists with problem solving, testing and documentation of billing systems. • Develops and maintains configuration decision and workflow documents. • Assists with analysis of data [conversion, analytics, quality, root cause]. • Attends meetings and is accountable for action items assigned to them or their team. • Review, evaluate, and test new software and software upgrades. • Ensures that the software functions efficiently daily and remains in safe functioning condition. • Maintain excellent customer service while working with NOMS physicians and team members. • Stays abreast of leading-edge information technology, communications, and healthcare software applications.

• Follow up on pending insurance claims to ensure timely processing and reimbursement • Review Explanations of Benefits (EOBs) to determine the appropriate next steps on each account • Contact insurance companies through phone and payer portals to obtain claim status and resolve outstanding issues • Investigate denied claims to identify root causes and determine the path to resolution • Prepare, submit, and track appeals, including assembling the supporting documentation each payer requires • Escalate complex or aged denials that require additional review or intervention • Maintain detailed, accurate documentation of all follow-up activity within the billing system • Monitor the status of assigned accounts to keep accounts receivable current and aging minimized • Surface recurring denial and payer trends to support process improvement across the billing team

• Lead development of the agentic connector pipeline — automating source profiling, field mapping, dbt model generation, and validation • Design and build AI-assisted data ingestion workflows using LLM APIs and agentic orchestration frameworks • Own the first 2–3 end-to-end agent-built connectors as proof of concept for the broader team • Establish internal AI tooling standards and patterns; mentor team on agentic development practices • Design, build, and maintain data pipelines and systems to meet business needs • Implement data quality control processes and contribute to observability frameworks • Document new and existing systems, designs, processes, and procedures • Work on-call 3–9% of the year, one week at a time, to support production failures and emergent business needs • Mentor and learn from colleagues through pair/mob programming, design reviews, and Lunch & Learns

• The RN Case Manager works with the clinical department and acts as a liaison with our physician practices. • The RN Case Manager advocates for personalized treatment options that address a patient’s unique care needs. • The RN Case Manager has a patient-forward approach that is centered in the value-based care model, offers education and guidance for navigating complex medical decisions, and creates and manages the plan of care for patients with chronic or serious conditions. • You will be responsible for using your assessment and communication skills to engage with patients in need of clinical support to determine and prioritize their needs. • You will deliver patient-centered care, provide exceptional customer service, and work within your scope of practice to provide evidence-based education, assessment, and care navigation. • Identify patient/caregiver education needs through telephonic assessment/engagement and ensure that the patient/caregiver has adequate information to participate in the successful transition back to their home setting from an inpatient or post-acute facility stay. • Conduct timely telephonic clinical outreach to identified patients. • Collaborate with PCPs, NPs, and other members of the healthcare team to coordinate care for patients and actively help keep them stable at home. • Serve as the point of contact and informational resource for patients, care teams, family/caregivers, payers, and community resources. • Implement interventions that improve health outcomes, lower costs, and enhance the patient experience. • Work collaboratively with provider offices, SNFs, hospitals, and other Clinical Services teams to support each patient’s needs efficiently and effectively. • Assist in coordination across the continuum of care while maintaining confidentiality. • Guide patients through the healthcare system and help them overcome barriers. • Coordinate treatment and services for patients. • Schedule medical appointments as needed. • Communicate about a patient’s health condition with the patient and their family. • Provide community resources to patients as needed and support resolution of SDoH. • Maintain a comprehensive working knowledge of community resources. • Assume accountability for the quality of care. • Continually seek new knowledge and learning that supports clinical care coordination. • Depending on market location, minimal travel may be required to visit provider offices to help enhance provider office engagement (less than 5%).

• Deliver targeted, intervention-based education with prioritization driven by practice performance data • Facilitate one-on-one provider education sessions, including DSP documentation coaching, ICD-10-CM specificity guidance, and clinical scenario-based learning • Participate in Pod meetings, RMO sessions, and practice-facing touchpoints to deliver vignette-style CDI education and reinforce documentation best practices • Design and maintain practice-specific education plans based on coding data, RAF trend analysis, and recapture opportunity outputs • Support provider understanding of point-of-care tools, suspect delivery outputs, and documentation expectations tied to CDI (Clinical Documentation Integrity) program goals • Respond to education needs and engagement escalations for practices with persistent documentation gaps • Monitor performance against practice-specific education plans, and propose and act upon improvement plans • Lead provider-facing webinars and educational sessions • Build and maintain the CDI clinical content library, including condition-specific advisories, documentation tip sheets, and slide-ready education modules, for use by RMO and CDI staff • Develop specialty-specific and prevalence-adjusted educational materials that align with CMS documentation standards and reflect real clinical scenarios • Collaborate with the VP, CDI & Coding Operations and QA Lead to ensure all clinical content reflects current coding guidelines and risk adjustment requirements • Conduct concurrent documentation reviews, evaluating clinical support for active diagnoses and identifying documentation gaps prior to or following encounters • Review coding outputs against clinical documentation to assess accuracy, specificity, and completeness; flag discrepancies for QA escalation or provider follow-up • Apply MEAT criteria in documentation review; identify conditions requiring addendum, query, or provider education • Contribute to the development of concurrent review workflows and eligibility criteria in coordination with the CDI Operations Lead and VP • Partner with RMOs, market medical directors, and practice-facing staff to align education delivery with population health and performance priorities • Track and report on education delivery, concurrent review activity, and provider engagement outcomes against established benchmarks • Escalate compliance concerns, coding accuracy issues, and documentation risks to the VP, CDI & Coding Operations in a timely manner.