Remote RN Case Manager

WHO IS GUIDEHEALTH? 

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

Join us as we put healthcare on a better path!!  

Job Description

WHAT YOU'LL BE DOING 

The Registered Nurse (RN) Case Manager enhances the quality and effectiveness of member care management by promoting wellness, improving satisfaction, and supporting cost-effective outcomes. This role partners collaboratively with members, providers, and clients to help individuals navigate the healthcare system and achieve personal health-related goals.

The RN Case Manager performs telephonic outreach, clinical assessments, data analysis, documentation, and reporting in compliance with federal and state regulations, NCQA standards, and company policies. This position plays a critical role in population health and value-based care initiatives.

• Analyze, sort, and interpret data to determine member eligibility for Population Health Management programs.
• Coordinate and deliver timely, effective, equitable, safe, and member-centric care in accordance with HMO processes.
• Manage assigned caseloads, including outreach, documentation, monitoring case progression, and case closure.
• Conduct telephonic outreach to members and providers to support care coordination and engagement.
• Perform clinical reviews and complete medical and behavioral health assessments.
• Address barriers to care by identifying social determinants of health, psychosocial issues, and member motivators.
• Educate members on navigating the HMO and broader healthcare system to promote informed decision-making.
• Promote quality, cost-effective interventions and outcomes.
• Meet all reporting and documentation standards while participating in collaborative meetings with internal teams and clients.
• Support operational initiatives to meet organizational goals, customer requirements, and satisfaction metrics.
• Maintain strict confidentiality of medical records, data, and all computer-based systems.
• Participate in Quality Management (QM) and Utilization Management (UM) committee meetings, as applicable, including preparation, documentation, data analysis, reporting, and follow-up (may require in-person attendance).
• Participate in off-hour and weekend call rotations, if applicable.
• Maintain continued professional development in accordance with the Illinois Nurse Practice Act.
• Perform additional duties as assigned and in alignment with annual program requirements.

What Success Looks Like

Within 3 Months

• Work primarily autonomously on daily assignments with routine daily or weekly interaction and oversight from a preceptor.
• Demonstrate foundational knowledge of the UM/PHM plan, MSA, processes, resources, EMR systems, and documentation platforms.
• Independently conduct telephonic outreach, documentation, and log reviews.
• Develop emerging skills in reporting and cross-departmental communication with clinical teams.

Within 6 Months

• Independently prepare for and present in UM meetings, if applicable.
• Perform daily responsibilities efficiently and in alignment with departmental processes and UM/PHM plans.
• Communicate professionally and effectively with members, providers, clients, and internal departments.
• Build rapport with members and stakeholders through telephonic engagement.

Within 12 Months

• Demonstrate advanced collaboration skills in reporting and cross-functional communication.
• Maintain in-depth knowledge of HMO products, departmental processes, MSAs, and UM/PHM plans, including annual changes.
• Develop comprehensive knowledge of contracted Independent Practice Associations (IPAs) and support coverage across IPAs as needed.
• Contribute to departmental process development and continuous improvement initiatives.
• Exhibit forward-thinking problem-solving skills with an understanding of productivity, incentives, departmental goals, and outcomes.

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

The salary range for this role is between $80,000-$83,000

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth, our values come to life in everything we do. 

• We are Driven by Accountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike. 
• Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve. 
• At Guidehealth, Every Voice Matters — we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy 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 flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

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. 

As a remote-first organization handling sensitive healthcare data, Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy, data security, and compliance requirements.

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 required internet speed is a minimum of 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements.