Job Description
Case managers coordinate healthcare at Guidehealth, navigating systems for members using telephonic outreach and assessments. They analyze data on eligibility, perform clinical reviews based on NCQA standards, and document progress to enhance care quality. Their interventions address barriers like social determinants, motivating members toward wellness goals while ensuring cost-effective outcomes in value-based frameworks.
Guidehealth delivers operational excellence in data-powered healthcare, focusing on affordability and provider fulfillment using AI and embedded teams. The company builds connections through managed service organizations for patient-provider bonds, serving partners with physician-led care emphasizing treatment outcomes. It commits to diversity, reflecting in remote setups that prioritize inclusion and collective strengths through empathy-driven actions.
Work involves sorting data for program assignments, facilitating outreach and meetings with clients. Nurses engage in QM committees preparing materials and minutes, rotating weekend calls occasionally. They use EMRs for evaluations, problem-solve psychosocial issues, and communicate verbally for informed decisions, maintaining HIPAA compliance in secured offices.
Remote positions in Illinois pay $80,000 to $85,000 annually, requiring RN licenses and 5 years experience. Schedules include flexibility but rotation in off-hours. Benefits offer health plans, 401(k) matches, paid parental leave, and EAP support, with development through continued education in nursing practices and internal resources for professional advancement.
Responsibilities
- Conduct telephonic outreach and assessments
- Analyze data for program eligibility
- Assist with navigation and wellness goals
- Participate in QM committee meetings
Requirements
- IL Registered Nurse License
- 5+ years in various healthcare settings
- Experience in case management
- Knowledge of utilization review and managed care