Remote RN Case Manager

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 problemsolve and assist members in realization of their personal healthcare 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 YOULL 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 membercentric 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 healthautonomy 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 costeffective interventions and outcomes.  
• Supporting operational aspects of the division to meet the organizations 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 followup tasks which may require inperson attendance.  
• Rotation in offhour/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 YOULL NEED TO HAVE 

• Current IL Registered Nurse License (State of Illinois requires Nursing Professional Staff to complete 20 hours of CE per 2year 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 multitasking 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 EMRs. 
• A high speed/secured home internet connection a private HIPAA compliant home office with a door that locks for security and privacy purposes and backup connection service options for internet outages.

WHAT WED LOVE FOR YOU TO HAVE

• Certification in Case Management preferred but not required

Additional Information :

The salary range for this role is between $75000.00 to $85000.00

BENEFITS:

All fulltime employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing valuebased 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 Flexible Time Off tailored to meet your needs and the needs of the business helping you achieve worklife 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.

COMPENSATION:

The listed compensation range listed is paid biweekly 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 EQUAL OPPORTUNITY EMPLOYMENT 

Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment. 

OUR COMITTMENT 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 Guidehealths custodianship as well as Guidehealth Intellectual Properties.  For any securityspecific roles the responsibilities would be further defined by the hiring manager. 

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 recommended internet speed is a minimum of 50 mbps download 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.

Remote Work :

Yes

Employment Type :

Fulltime