Job Description

About GuideHealth

GuideHealth is a data?powered, performance?driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, GuideHealth leverages remotely?embedded HealthGuides and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician?led, GuideHealth empowers our partners to deliver high?quality healthcare focused on outcomes and value inside and outside the exam room for all patients.

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 members 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 clients and members alike to promote wellness, problem?solve, and assist members in the realization of their personal health?care related goals. This role includes telephonic member and provider outreach, data collection and analysis, reporting, clinical review, medical and behavioral health assessments, and documentation in compliance with Federal/State regulation, NCQA standard, and company policies and procedures. This position is part of the Value Based Care Services team.

Responsibilities

• 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 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 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

• Current and active IL Registered Nurse License; temporary or pending licenses are not acceptable. (State of Illinois requires nursing professionals 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 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 back?up connection service options for internet outages.

Preferred

• Certification in Case Management (preferred but not required).

Salary Range

The salary range for this role is between $80,000.00 and $83,500.

ALIVE with Purpose

• We are driven by accountability grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
• Always growing, always learning staying curious and continuously improving inspires us to shape a better future for healthcare.
• With collaborative innovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
• Every voice matters we believe our collective strength is rooted in the unique perspectives of each team member.
• And through empathy in action, we build stronger connections with those who count on us.

Benefits

• Work from Home: fully remote with flexibility.
• Comprehensive Medical, Dental, and Vision plans.
• 401(k) plan includes a 3% employer match to your 6% contribution.
• Life and Disability insurance, including voluntary life options.
• Employee Assistance Program (EAP) to help through tough times.
• Paid time off plans for work?life balance.
• Paid parental leave.
• Professional growth resources and development opportunities.

Compensation

Listed compensation is paid bi?weekly per standard payroll practices. Final base pay decisions are dependent upon a variety of factors including skill set, years of relevant experience, education, location, licensure, and certifications.

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.

Protection of Patient and Company Data

This position is responsible for following all security policies and procedures to protect all PHI and PII under GuideHealths custodianship as well as GuideHealth Intellectual Properties.

Remote Work Technical Requirements

GuideHealth is a fully remote company. We provide new employees with the necessary equipment at no charge. Employees provide their own internet connection capable of video calls and connecting to various internal and external systems. The required internet speed is a minimum of 100?Mbps download and 10?Mbps upload. Please run a speed test here to confirm your connection meets these requirements.

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Job Tags

Bi-weekly pay, Temporary work, Work experience placement, Local area, Work from home, Home office, Weekend work,

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