Remote RN Case Manager: Value-Based Care Partner

Guidehealth; Chicago (IL); Remote; USD 80,000 - 83,000; Full time

Benefits offered by this job

Remote work

Health insurance

401(k) employer match

Life and Disability insurance

EAP

Paid time off

Parental leave

Learning and development

Job summary

Guidehealth is seeking an Illinois-licensed registered nurse to join the Value Based Care Services team as an RN Case Manager. This remote role focuses on member management, cost-effectiveness, and navigating the healthcare system with a patient-centered approach.

You will perform telephonic outreach, data collection, clinical reviews, and documentation in compliance with federal/state regulations. Strong case management and remote-work experience are essential.

Qualifications

• Current IL Registered Nurse License required.
• Minimum of five years of experience in diverse health care settings.
• Experienced in Case Management and Chronic Condition Management.
• Previous remote/telephonic work experience.
• Knowledge of utilization review, quality improvement, managed care, and/or community health.
• Experience with EMR systems and basic data handling.

Responsibilities

• Manage case assignments with extensive patient outreach and documentation.
• Analyze data to determine member eligibility for Population Health management.
• Coordinate timely, safe, and member-centric care following HMO processes.
• Meet reporting and documentation standards and collaborate with staff and clients.
• Help members achieve wellness and navigate the healthcare system.
• Educate members on navigating the HMO and care options for cost-effective outcomes.
• Support division operations to meet customer requirements and satisfaction.
• Maintain confidentiality of all medical data and systems.
• Participate in QM/UM Committee activities and prepare materials as needed.
• Rotate in off-hour/weekend calls if applicable.
• Pursue ongoing professional development per Illinois Nursing Practice Act.

Skills

Nursing

Case Management

Remote Work

Data Analysis

Education

IL RN License

Tools

EMR Systems

MS Word

Excel

Access

Outlook

Job description

Guidehealth is seeking an Illinois-licensed registered nurse to join the Value Based Care Services team as an RN Case Manager. This remote role focuses on member management, cost-effectiveness, and navigating the healthcare system with a patient-centered approach.

You will perform telephonic outreach, data collection, clinical reviews, and documentation in compliance with federal/state regulations. Strong case management and remote-work experience are essential.