Remote RN Case Manager for Value-Based Care

Guidehealth; Gary (IN); Remote; USD 81,000 - 99,000; Full time

Benefits offered by this job

Work from Home

Medical, Dental, Vision

401(k) with 3% employer match

Life and Disability insurance

EAP

Paid time off

Paid parental leave

Learning & development

Job summary

Guidehealth is seeking a remote RN Case Manager with an Illinois nursing license to enhance member management, satisfaction, and cost effectiveness. You will support wellness, coordinate care, and navigate the healthcare system as part of the Value Based Care Services team.

The role involves telephonic outreach, data collection, clinical reviews, and adherence to federal/state regulations and company policies. Remote work enables flexible collaboration with clients and providers.

Qualifications

• Nurse with IL license and 20 hours CE per 2-year renewal cycle.
• Minimum five years of experience in varied health settings.
• Remote/telephonic work experience preferred.
• Strong clinical judgment and communication skills.
• Proficiency with MS Word, Excel, Access, PDF, Outlook and EMR systems.

Responsibilities

• Analyze data to determine member eligibility for Population Health management.
• Coordinate and provide care that is timely, effective, and member-centric following HMO processes.
• Manage case assignments: outreach, documentation, monitoring, and closure.
• Meet reporting and documentation standards and participate in cross-team meetings.
• Assist members in wellness and autonomy, addressing barriers and psychosocial issues.
• Educate members on navigating the HMO and healthcare spectrum for quality care.
• Support division operations to meet customer requirements and satisfaction.
• Maintain confidentiality of medical data and programs.
• Participate in QM/UM committee meetings as needed, possibly in person.
• Rotate in off-hour or weekend calls if applicable.
• Pursue ongoing professional growth per Illinois Practice Act.

Skills

Remote work

Clinical communication

Time management

Independent work

Tools

MS Word

Excel

Access

PDF

Outlook

EMR systems

Job description

Guidehealth is seeking a remote RN Case Manager with an Illinois nursing license to enhance member management, satisfaction, and cost effectiveness. You will support wellness, coordinate care, and navigate the healthcare system as part of the Value Based Care Services team.

The role involves telephonic outreach, data collection, clinical reviews, and adherence to federal/state regulations and company policies. Remote work enables flexible collaboration with clients and providers.