Remote RN Case Manager

Job posted 2 days ago. Be among the first 25 applicants. About Guidehealth Guidehealth is a data‑powered, performance‑driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve patients’ health, and restore the fulfillment of practicing medicine for providers. Powered by AI and predictive analytics, we leverage remotely‑embedded Healthguides and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician‑led, we empower partners to deliver high‑quality, outcome‑focused care inside and outside the exam room for all patients. Job Description As a registered nurse with an Illinois nursing license, you will work remotely to enhance member management quality, maximize satisfaction and cost effectiveness, and assist in navigating the health care system as a collaborative health partner in the healthcare team. As an RN Case Manager the RN works closely with clients and members to promote wellness, problem‑solve, and assist members in achieving their personal health‑care related goals. Responsibilities include telephonic outreach, data collection and analysis, reporting, clinical review, medical and behavioral health assessments, and documentation in compliance with Federal/State regulation, NCQA standards, and company policies. 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 while following HMO processes. Managing case assignments, including outreach, documentation, monitoring for 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. Supporting operational aspects of the division to meet organizational customer requirements and satisfaction. Maintaining confidentiality related to all computer programs, medical records, and data. Participating in QM/UM Committee Meetings, including material preparation, minutes, data collection, analysis, reporting, and follow‑up tasks which may require in‑person attendance. Rotating in off‑hour/weekend calls if applicable. Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing practice as outlined in the Illinois Practice Act. Other responsibilities as assigned and per any changes in annual program requirements. Qualifications Current Illinois Registered Nurse License (must have completed 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, strong verbal and written communication skills. Strong organizational, problem‑solving, and time‑management skills. Ability to ensure timely completion of projects and assignments. Ability to prioritize and react based on rapidly changing business needs. Capability to work independently and remotely with multitasking skills for fast‑paced workflows. Proficient with software including word processing and spreadsheets, Microsoft Office, PDF, Outlook, and experience navigating multiple EMRs. High‑speed, secured home internet connection, a private HIPAA‑compliant office with a lockable door, and backup internet service. What We'd Love for You to Have Certification in Case Management (preferred but not required). Additional Information The salary range for this role is $80,000.00 to $85,000.00, paid bi‑weekly. Benefits Work from Home: fully remote with flexible schedule. Comprehensive Medical, Dental, and Vision plans. 401(k) plan with 3% employer match to your 6% contribution. Life and Disability insurance, plus voluntary life options. Employee Assistance Program (EAP). Paid time off and parental leave. Professional growth resources and development opportunities. Compensation Final base pay decisions will consider skills, experience, education, location, and licensure/certifications. Equal Opportunity Employer Guidehealth is an equal opportunity employer. We enthusiastically embrace diversity, inclusion, and belonging. Employment decisions are made without regard to race, religion, color, age, sex, sexual orientation, gender identity, national origin, citizenship, marital status, familial status, disability, family or medical leave, military status, pregnancy, or any other protected classification under federal, state, and local laws. Data Protection This position requires strict adherence to all security policies and procedures to protect PHI and PII under Guidehealth’s custodianship and intellectual property. Remote Work Technical Requirements Employees provide their own internet connection (minimum 100 Mbps download, 10 Mbps upload) capable of video calls and internal system access. Guidehealth supplies necessary equipment at no charge. #J-18808-Ljbffr