RN Case Manager - Remote

Guidehealth•Chicago, IL

9h•$80,000 - $83,000•Remote

About The Position

Guidehealth is seeking a registered nurse with an Illinois nursing license to work remotely as an RN Case Manager on the Value Based Care Services team. The role enhances member management, satisfaction, and cost effectiveness, and helps members navigate the healthcare system in collaboration with their care teams. The RN works with clients and members to promote wellness, solve problems, and support members in achieving personal healthcare goals. The position includes telephonic outreach to members and providers; data collection, analysis, and reporting; clinical review; medical and behavioral health assessments; and documentation in compliance with federal and state regulations, NCQA standards, and company policies and procedures. The role also supports program operations, confidentiality, and professional nursing development. Participation in quality management and utilization management committee activities may require in-person attendance, and the role may include rotation in off-hour or weekend calls if applicable.

Requirements

Current Illinois Registered Nurse license; Illinois requires nursing professional staff to complete 20 hours of continuing education per two-year license renewal cycle.
At least five years of experience in a variety of healthcare settings.
Extensive experience in case management and chronic condition management.
Previous remote and/or telephonic work experience.
Knowledge of utilization review, quality improvement, managed care, and/or community health.
Basic knowledge of case management principles, healthcare management, and reimbursement components, with experience in motivational interviewing.
Excellent clinical judgment and strong verbal and written communication skills.
Strong organizational, problem-solving, and time-management skills.
Ability to complete projects and assignments on time.
Ability to prioritize and respond to rapidly changing business needs.
Ability to work independently and remotely, multitask, and manage fast-paced workflows.
Knowledge of word processing and spreadsheet software, including MS Word, Excel, Access, PDF, and Outlook.
Experience navigating multiple EMRs.
For remote work, provide an internet connection capable of video calls and connecting to internal and external systems, with minimum speeds of 100 Mbps download and 10 Mbps upload.
Disclose any secondary employment and remain accessible during stated working hours; team members are asked to join virtual meetings with cameras on.

Nice To Haves

Certification in Case Management.

Responsibilities

Manage case assignments, including extensive patient outreach by telephone, documentation, monitoring case progression, and case closure.
Pull, sort, and analyze data to determine member eligibility for the Population Health Management program.
Coordinate and provide timely, effective, equitable, safe, and member-centric care while following HMO processes.
Meet reporting and documentation standards and participate in collaborative meetings with department staff and clients.
Help members achieve wellness and health autonomy by addressing barriers, social determinants, member motivators, and psychosocial issues.
Educate members to help them make informed decisions and navigate the HMO and healthcare system, promoting quality and cost-effective interventions and outcomes.
Support division operations to meet organizational customer requirements and satisfaction.
Maintain confidentiality of computer programs, medical records, and data.
Participate in QM/UM Committee meetings, including preparing materials and minutes, collecting and analyzing data, reporting, and follow-up tasks; some participation may require in-person attendance.
Participate in off-hour or weekend call rotation if applicable.
Pursue continued professional growth and education consistent with current nursing care practice under the Illinois Practice Act.
Perform other responsibilities as assigned and as annual program requirements change.
Follow security policies and procedures to protect PHI, PII, and Guidehealth intellectual property.