Job Description

As a registered nurse with an Illinois nursing license, you will work remotely to enhance the quality of member management, maximize both satisfaction and cost effectiveness, and assist in navigating the health care system as a collaborative health partner in their health care team. As an RN Case Manager, the RN will work closely with client and members alike to promote wellness, problem-solve, and assist members in realization of their personal health-care related goals.

This role includes telephonic member and provider outreach, data collection and analyzation, reporting, clinical review, medical and behavioral health assessments, and documentation in compliance with Federal/State regulation, NCAQ standard, and company policies and procedures. This position is part of the Value Based Care Services team.

WHAT YOU'LL BE DOING

• Pulling, sorting, and analyzing data to determine member eligibility for the Population Health management Program.
• Coordinating and providing care that is timely, effective, equitable, safe, and member-centric while following HMO processes.
• Managing case assignments which includes outreach, documentation, monitoring for case progression, and case closure.
• Meeting reporting and documentation standards while engaging in collaborative meetings with department staff and clients.
• Assisting members in reaching wellness and health-autonomy by addressing barriers, social determinants, member motivators, and psychosocial issues.
• Helping members make informed decisions by educating them on navigation through the HMO and healthcare spectrum while promoting quality and cost-effective interventions and outcomes.
• Supporting operational aspects of the division to meet the organization's customer requirements and satisfaction.
• Maintaining confidentiality related to all computer programs, medical records, and data.
• Participation in QM/UM Committee Meetings including material preparation, minutes, data collection, and analysis, reporting, and follow-up tasks which may require in-person attendance.
• Rotation in off-hour/weekend calls if applicable.
• Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Practice Act.
• Other responsibilities as assigned and per any changes in annual program requirements.

Qualifications

WHAT YOU'LL NEED TO HAVE

• Current IL Registered Nurse License (State of Illinois requires Nursing Professional Staff to complete 20 hours of CE per 2-year license renewal cycle).
• Minimum of five years of experience in a variety of health care settings.
• Highly experienced in Case Management and Chronic Condition Management.
• Knowledge of utilization review, quality improvement, managed care, and/or community health.
• Previous remote and/or telephonic work experience.
• Basic knowledge of case management principles, healthcare management, and reimbursement components, with experience in motivational interviewing.
• Excellent clinical judgment, as well as highly skilled in verbal and written communication.
• Strong organizational. problem solving, and time management skills necessary.
• Ability to ensure timely completion of projects and assignments.
• Ability to prioritize and react based on rapidly changing business needs.
• Must have ability to work independently and remotely with multi-tasking skills for fast paced workflows.
• Must possess software knowledge including word processing and spreadsheets, computer skills including MS Word, Excel, Access, PDF, Outlook, etc.
• Experience navigating multiple EMR's.
• A high speed/secured home internet connection, a private HIPAA compliant home office with a door that locks for security and privacy purposes, and back-up connection service options for internet outages.

WHAT WE'D LOVE FOR YOU TO HAVE

• Certification in Case Management preferred but not required

Additional Information

The salary range for this role is $90,000.00

BENEFITS:

While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth's custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

As a remote-first organization handling sensitive healthcare data, Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy, data security, and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements.

SECONDARY EMPLOYMENT

At Guidehealth, we value transparency and collaboration as part of our commitment to excellence. As your primary employer, we kindly ask all team members to disclose any secondary employment, regardless of whether it may present a potential conflict of interest.

To ensure smooth teamwork and availability, employees must be accessible during our stated working hours. We foster connection and engagement by asking team members to join virtual meetings with their cameras on.

Videos To Watch
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