RN Case Manager - Remote

At Guidehealth, we believe everyone deserves access to high-quality, affordable healthcare that puts patients first. As a physician-led, value-based care healthcare company, our mission is to improve health outcomes by making care more accessible, personalized, and connected.

Driven by empathy and supported by AI and predictive analytics, our Health guides™ work alongside patients and providers to remove barriers to care, build meaningful relationships, and help patients navigate their healthcare journeys. By combining compassionate human support with innovative technology and clinical expertise, we empower providers to focus on what matters most—delivering exceptional care and helping patients live healthier lives.

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, problem-solve, and assist members in realization of their personal health-care 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 YOU’LL BE DOING

• Managing case assignments which includes extensive patient outreach via telephone, documentation, and monitoring for case progression, and case closure.
• 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.
• 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 organization’s 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.

WHAT YOU'LL NEED TO HAVE FOR SUCCESS

• Current IL Registered Nurse License (State of Illinois requires Nursing Professional Staff 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.
• 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…