Job Description
Members achieve health goals through coordinated case management from remote nurses. Case managers conduct outreach, assessments, and navigation to promote wellness, cost-effectiveness, and informed healthcare decisions.
Guidehealth operates as a performance-driven healthcare company using AI and predictive analytics, embedded Healthguides, and managed service organization for provider and patient connections, serving partners to deliver quality healthcare focused on outcomes.
Managers pull and analyze data for member eligibility in population health programs, coordinate timely effective care per HMO processes, manage case assignments including outreach and monitoring, meet documentation standards in meetings, address barriers like social determinants and psychosocial issues, educate on healthcare navigation, support operational aspects, maintain confidentiality, participate in QM/UM committees including attendance, prepare for meetings, rotate in off-hour calls, and ensure professional growth per Illinois Practice Act. Minimum 5 years healthcare experience required, with IL RN license, temporary licenses unacceptable, 20 CE hours per renewal cycle.
Roles require active Illinois Registered Nurse License with 5+ years varied healthcare experience, knowledge of utilization review, quality improvement, managed care, community health, motivational interviewing, strong clinical judgment, verbal/written communication, organizational problem-solving skills, ability to work independently remotely, multitasking for workflows, software knowledge including MS Word, Excel, Access, PDF, Outlook, experience with multiple EMRs, high-speed secured internet minimum 100 mbps download 10 mbps upload, private HIPAA-compliant home office with locking door. Pay $80,000 to $85,000 annually, full-time remote. Benefits include comprehensive medical, dental, vision, 401(k) with 3% match to 6%, life and disability insurance, EAP, paid time off, parental leave. Professional development through continued education, meeting participation.
Responsibilities
- Pull, sort, analyze data for member eligibility in population health management
- Coordinate and provide timely, effective, equitable, safe, member-centric care
- Manage case assignments including outreach, documentation, monitoring
- Assist members in reaching wellness by addressing barriers and motivators
- Help members navigate HMO and healthcare spectrum with informed decisions
Requirements
- Current and active IL Registered Nurse License
- Minimum of five years experience in variety of health care settings
- Highly experienced in Case Management and Chronic Condition Management
- Knowledge of utilization review, quality improvement, managed care, community health
- Previous remote and/or telephonic work experience