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.
What you'll need to have for success:
Current and active IL Registered Nurse License. Temporary licenses or licenses that are under consideration with the Board of Nursing are not acceptable.
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.
What we would love for you to have:
Certification in Case Management preferred but not required
The salary range for this role is between $78,000.00 to $83,000.00 per year.
ALIVE with Purpose: How We Thrive at Guidehealth
At Guidehealth, our values come to life in everything we do.
We are Driven by A ccountability - grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
Always Growing, Always L earning - staying curious and continuously improving inspires us to shape a better future for healthcare.
With Collaborative I nnovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
At Guidehealth, Every V oice Matters - we believe our collective strength is rooted in the unique perspectives of each team member.
And through E mpathy in Action, we build stronger connections with those who count on us.
This is what it means to be ALIVE with purpose. This is how we thrive - together - at Guidehealth.
Benefits
While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:Work from Home: Guidehealth is a fully remote company, providing you the flexHealth insuranceVision insuranceRemote work options
Additional Information
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.
Guidehealth · Chicago, IL