Remote RN Case Manager: Care Coordination & Outcomes

Guidehealth; St. Louis (MO); Remote; USD 81,000 - 99,000; Full time

Benefits offered by this job

Work from Home

Medical insurance

Dental & Vision plans

401(k) with employer match

Life & Disability insurance

EAP & Paid time off

Parental leave

Job summary

Guidehealth in the United States seeks an experienced RN Case Manager to work remotely with Illinois licensure. You will oversee member management, promote wellness, and support cost-effective care within a value-based care framework.

You’ll perform data collection, clinical reviews, and documentation, coordinate care, and ensure compliance with regulations while collaborating with clients and internal teams. This is a full-time, remote role with competitive benefits.

Qualifications

• Current IL Registered Nurse License with CE requirements per renewal cycle.
• Minimum five years in varied healthcare settings with case management experience.
• Remote/telephonic work experience preferred.
• Knowledge of utilization review, quality improvement, and managed care.
• Experience navigating multiple EMRs and healthcare systems.
• Strong clinical judgement and communication skills.

Responsibilities

• Pull, sort, and analyze data to determine member eligibility for programs.
• Coordinate timely, equitable, safe, and member-centric care following processes.
• Manage case assignments, outreach, documentation, and case progression.
• Meet reporting standards and collaborate with staff and clients.
• Educate members on navigating the healthcare system and cost-effective options.
• Maintain confidentiality across systems and data.
• Prepare materials and assist QM/UM committee activities; possible in-person tasks.
• Rotate in off-hour/weekend calls as applicable.

Skills

Verbal communication

Written communication

Organizational skills

Time management

Problem solving

Independent remote work

Clinical judgement

Collaboration

Education

IL RN License

Tools

MS Word

MS Excel

MS Access

PDF

Outlook

EMR navigation

Job description

Guidehealth in the United States seeks an experienced RN Case Manager to work remotely with Illinois licensure. You will oversee member management, promote wellness, and support cost-effective care within a value-based care framework.

You’ll perform data collection, clinical reviews, and documentation, coordinate care, and ensure compliance with regulations while collaborating with clients and internal teams. This is a full-time, remote role with competitive benefits.