Remote RN Case Manager - Value-Based Care

Guidehealth; Chicago (IL); Remote; USD 81,000 - 99,000; Full time

Benefits offered by this job

Work from Home

Medical, Dental, Vision

401(k) with match

Life & Disability Insurance

Employee Assistance Program

Paid Time Off

Paid Parental Leave

Learning & Development resources

Job summary

Guidehealth is seeking an Illinois-licensed registered nurse to join its remote Value Based Care Services team as an RN Case Manager. You will conduct telephonic outreach, assess needs, coordinate care, and document in compliance with federal/state regulations.

Five years' healthcare experience and strong communication are required; remote work demands reliable internet and HIPAA privacy. The role emphasizes wellness coaching, data analysis, and collaboration with providers to ensure

Qualifications

• Current IL Registered Nurse License with CE requirements.
• Minimum of five years of healthcare experience across settings.
• Experience in Case Management and Chronic Condition Management.
• Knowledge of utilization review, quality improvement, managed care, and/or community health.
• Remote and/or telephonic work experience.
• Knowledge of case management principles and reimbursement components; experience with motivational interviewing.
• Excellent clinical judgment and communication skills.
• Strong organizational and time-management abilities.
• Ability to work independently and remotely with multitasking.
• Proficiency with MS Word, Excel and other office software.
• Experience navigating multiple EMRs.
• Reliable high-speed internet and a private HIPAA-compliant home office.

Responsibilities

• Pull data to determine member eligibility for Population Health management.
• Coordinate timely, safe, and cost-effective member care following HMO processes.
• Manage case assignments including outreach, documentation, progression, and closure.
• Meet reporting standards and participate in collaborative meetings with staff and clients.
• Assist members in wellness and autonomy by addressing barriers and social determinants.
• Educate members on navigating the HMO and healthcare system for quality care.
• Support division operations to meet client requirements and satisfaction.
• Maintain confidentiality of PHI/PII in all systems and documents.
• Participate in QM/UM Committee meetings with data collection and follow-up tasks.
• Rotation in off-hours/weekend calls as applicable.
• Pursue ongoing professional growth per Illinois Practice Act.
• Other duties as assigned.

Skills

IL RN License

Remote work

Case Management

Chronic Condition Management

Communication skills

EMR navigation

MS Office (Word/Excel)

Tools

EMR systems

MS Office suite

Job description

Guidehealth is seeking an Illinois-licensed registered nurse to join its remote Value Based Care Services team as an RN Case Manager. You will conduct telephonic outreach, assess needs, coordinate care, and document in compliance with federal/state regulations.

Five years' healthcare experience and strong communication are required; remote work demands reliable internet and HIPAA privacy. The role emphasizes wellness coaching, data analysis, and collaboration with providers to ensure