Remote RN Case Manager

Guidehealth; Aurora (IL); Remote; USD 75,000 - 85,000; Full time

Job summary

Guidehealth is seeking a Registered Nurse Case Manager to work remotely, enhancing member management and satisfaction. The role involves telephonic outreach, data analysis, and compliance with healthcare regulations. Ideal candidates will have extensive experience in healthcare and strong communication skills. Join a company dedicated to improving healthcare outcomes and empowering patients.

Benefits

Health coverage

401(k) with employer match

Flexible time off

Professional development resources

Qualifications

• Minimum five years of experience in diverse healthcare settings.
• Experience in Case Management and Chronic Condition Management.
• Knowledge of utilization review and managed care.

Responsibilities

• Analyzing data to determine member eligibility for programs.
• Coordinating and providing member-centric care.
• Managing case assignments and ensuring documentation standards.

Skills

Clinical judgment

Communication

Organizational skills

Problem-solving

Time management

Education

Current IL Registered Nurse License

Tools

MS Word

Excel

Access

PDF

Outlook

Job description

21 hours ago Be among the first 25 applicants

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

As a registered nurse with an Illinois nursing license, you will work remotely to enhance member management, maximize satisfaction and cost-effectiveness, and assist members in navigating the healthcare system as a collaborative health partner in their healthcare team. As an RN Case Manager, you will work closely with clients and members alike to promote wellness, problem-solve, and help members realize their personal healthcare goals.

This role includes telephonic outreach to members and providers, data collection and analysis, reporting, clinical review, health assessments, and documentation in compliance with regulations, standards, and company policies. This position is part of the Value Based Care Services team.

What You’ll Be Doing

• 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, and closure.
• Ensuring reporting and documentation standards are met while collaborating with staff and clients.
• Helping members achieve wellness and health autonomy by addressing barriers and social determinants.
• Educating members on navigating healthcare options and promoting quality and cost-effective interventions.
• Supporting operational aspects to meet customer satisfaction requirements.
• Maintaining confidentiality of all medical and data records.
• Participating in QM/UM meetings, including preparing materials, documentation, data collection, and analysis.
• Rotating in off-hour/weekend calls if applicable.
• Engaging in ongoing professional development as per Illinois Practice Act.
• Performing other duties as assigned or updated.

Qualifications

• Current IL Registered Nurse License (with 20 hours of CE every 2 years).
• Minimum five years of experience in diverse healthcare settings.
• Experience in Case Management and Chronic Condition Management.
• Knowledge of utilization review, quality improvement, managed care, and community health.
• Previous remote or telephonic work experience.
• Basic knowledge of case management principles, healthcare management, and motivational interviewing.
• Excellent clinical judgment and communication skills.
• Strong organizational, problem-solving, and time management skills.
• Ability to work independently and remotely, managing multiple tasks efficiently.
• Proficiency with MS Word, Excel, Access, PDF, Outlook, and navigating EMRs.
• Reliable high-speed internet and a private, HIPAA-compliant home office setup.

Preferred Qualifications

• Certification in Case Management (preferred but not required).

Additional Information

The salary range is $75,000 to $85,000, paid bi-weekly, with final offers dependent on experience, skills, and location.

Our Values

We thrive by being accountable, continuously learning, innovating collaboratively, valuing every voice, and practicing empathy in action. This is what it means to be ALIVE with purpose at Guidehealth.

Benefits

Full-time employees working 30+ hours/week are eligible for benefits including remote work, health coverage, 401(k) with employer match, life and disability insurance, EAP, flexible time off, parental leave, and professional development resources.

Equal Opportunity Employment

We are committed to diversity and inclusion, making employment decisions without regard to protected statuses under applicable laws.

Data Security and Remote Work Requirements

Follow all policies to protect PHI and PII. Employees need a reliable internet connection (minimum 50 Mbps download, 10 Mbps upload) and a secure home workspace. Equipment is provided at no cost.