Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Their 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 its partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. Join to put healthcare on a better path.

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, you will work closely with clients and members to promote wellness, problem-solve, and assist members in realization of their personal health-care related goals. The 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, NCAQ standard, and company policies and procedures. This position is part of the Value Based Care Services team. WHAT YOU’LL BE DOING - Pulling, sorting, and analyzing data to determine member eligibility for the Population Health management Program. - Coordinating and providing timely, effective, equitable, safe, and member-centric care following HMO processes. - Managing case assignments including 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 customer requirements and satisfaction. - Maintaining confidentiality related to 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, with possible in-person attendance. - Rotation in off-hour/weekend calls if applicable. - Responsible for continued professional growth and education reflecting knowledge of current nursing care practice as outlined in the Illinois Practice Act. - Other responsibilities as assigned and per any annual program requirement changes.

WHAT YOU'LL NEED TO HAVE - Current Illinois Registered Nurse License (requires 20 hours of CE per 2-year license renewal cycle). - Minimum of five years of experience in various healthcare settings. - Highly experienced in Case Management and Chronic Condition Management. - Knowledge of utilization review, quality improvement, managed care, 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 and strong verbal and written communication skills. - Strong organizational, problem-solving, and time management skills. - Ability to complete projects timely and prioritize based on business needs. - Ability to work independently and remotely with multi-tasking skills for fast-paced workflows. - Software knowledge including MS Word, Excel, Access, PDF, Outlook. - Experience navigating multiple EMRs. - High speed/secured home internet, private HIPAA compliant home office with a locking door. - Certification in Case Management preferred but not required.

The salary range is $80,000 to $85,000. ALIVE with Purpose: How We Thrive at Guidehealth - Accountability: transparency, reliability, and integrity. - Always Growing, Always Learning: continuous improvement. - Collaborative Innovation: creative problem-solving. - Every Voice Matters: valuing unique perspectives. - Empathy in Action: building strong connections. Benefits: - Remote work flexibility. - Comprehensive Medical, Dental, and Vision plans. - 401(k) plan with 3% employer match. - Life and Disability insurance. - Employee Assistance Program (EAP). - Paid time off plans. - Paid parental leave. - Resources for professional growth and development. Compensation is paid bi-weekly with final base pay dependent on factors like skills, experience, education, location, and certifications. Guidehealth is an equal opportunity employer committed to diversity and inclusion. The role requires adherence to security policies protecting PHI, PII, and company data. Technical Requirements: - Fully remote role with company-provided equipment. - Employee must have internet meeting minimum speed requirements (50 mbps download, 10 mbps upload) and a private HIPAA compliant workspace in their home.