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 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

• 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 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.

Qualifications

WHAT YOU'LL NEED TO HAVE

• 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.
• 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 EMR’s.
• 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.

WHAT WE'D LOVE FOR YOU TO HAVE

• Certification in Case Management preferred but not required

Additional Information

All your information will be kept confidential according to EEO guidelines.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging are at the core of Guidehealth’s 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.

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The recommended internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.