Remote RN Case Manager for Value-Based Care

Guidehealth; Kenosha (WI); Remote; USD 81,000 - 99,000; Full time

Benefits offered by this job

Work from Home

Medical insurance

Dental plan

Vision plan

401(k) with match

Life insurance

Disability insurance

Employee Assistance Program

Paid time off

Paid parental leave

Learning and development

Job summary

Guidehealth, a data-powered healthcare company, is seeking a licensed RN Case Manager to work remotely from Wisconsin. You will collaborate with clients and members to promote wellness, navigate the health system, and manage case assignments from intake to closure.

You will perform telephonic outreach, data collection, clinical reviews, and documentation compliant with state and federal regulations. Strong case management, chronic condition experience, and remote work skills are required; HL7

Qualifications

• 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.

Responsibilities

• Pull and analyze data to determine member eligibility.
• Coordinate care that is timely, safe, and member-centric.
• Manage case assignments including outreach and documentation.
• Meet reporting and documentation standards while engaging in collaborative meetings with department staff and clients.
• Assist members in reaching wellness and health-autonomy by addressing barriers and social determinants.
• Educate members on navigation through the HMO and healthcare spectrum.
• Support operational aspects of the division to meet the organization’s customer requirements and satisfaction.
• Maintain confidentiality related to all computer programs, medical records, and data.
• Participation in QM/UM Committee Meetings including material preparation, minutes, data collection, and analysis, reporting, and follow-up tasks which may require in-person attendance.
• Rotation in off-hour/weekend calls if applicable.
• Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Practice Act.
• Other responsibilities as assigned and per any changes in annual program requirements.

Skills

Case Management

Remote Work

Data Analysis

EMR Navigation

Communication

Tools

MS Word

Excel

Access

PDF

Outlook

EMR systems

Job description

Guidehealth, a data-powered healthcare company, is seeking a licensed RN Case Manager to work remotely from Wisconsin. You will collaborate with clients and members to promote wellness, navigate the health system, and manage case assignments from intake to closure.

You will perform telephonic outreach, data collection, clinical reviews, and documentation compliant with state and federal regulations. Strong case management, chronic condition experience, and remote work skills are required; HL7