Rn Case Manager

WHO IS GUIDEHEALTH?

At Guidehealth, our mission is to enhance healthcare affordability for patients and restore the fulfillment of practicing medicine for providers. As a physician-led company, we recognize that streamlining administrative tasks and harnessing the power of predictive analytics and AI enable our partner physician practices to prioritize delivering high-quality healthcare focused on outcomes and value.

Driven by empathy, we empower physicians to anticipate the needs of patients requiring more attention, strengthen connections between patients and physicians with virtually-embedded Healthguides, and leverage AI and analytics to proactively avoid preventable events. This approach results in increased levels of patient and practice engagement, ultimately leading to more significant positive impacts on patients.

Join us as we put healthcare on a better path!!

An Illinois Registered Nurse that will work to enhance the quality of member management, maximize both satisfaction and cost effectiveness, and assist in navigating the health care system as a collaborative health partner in their health care team. As an RN Case Manager, the RN will work closely with client and members alike to promote wellness, problem-solve, and assist members in realization of their personal health-care related goals.   

This role includes telephonic member and provider outreach, data collection and analyzation, reporting, clinical review, medical and behavioral health assessments, and documentation in compliance with Federal/State regulation, NCAQ standard, and company policies and procedures. This position is part of the Value Based Care Services team. 

WHAT YOU’LL BE DOING  

• Pulling, sorting, and analyzing data to determine member eligibility for the Population Health management Program.  
• Coordinating and providing care that is timely, effective, equitable, safe, and member-centric while following HMO processes.  
• Managing case assignments which includes outreach, documentation, monitoring for case progression, and case closure.  
• Meeting reporting and documentation standards while engaging in collaborative meetings with department staff and clients.  
• Assisting members in reaching wellness and health-autonomy by addressing barriers, social determinants, member motivators, and psychosocial issues.  
• Helping members make informed decisions by educating them on navigation through the HMO and healthcare spectrum while promoting quality and cost-effective interventions and outcomes.  
• Supporting operational aspects of the division to meet the organization’s customer requirements and satisfaction.  
• Maintaining confidentiality related to all computer programs, medical records, and data.  
• Participation in QM/UM Committee Meetings (if applicable) 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. 

WHAT SUCCESS LOOKS LIKE 

IN 3 MONTHS 

• Ability to work primarily autonomously with completion of daily assignments with daily/weekly interaction and oversight from preceptor 
• Basic knowledge and ability of navigation of UM/PHM Plan, MSA, processes, resources, EMR, and documentation platforms.  
• Ability to autonomously perform telephonic outreach, documentation and log reviews 
• Emerging skills in reporting and cross-departmental communications with other clinical departments. 

IN 6 MONTHS 

• Ability to autonomously perform UM meeting prep and presentations (if applicable).  
• Ability to perform daily tasks in an organized and efficient manner while adhering to departmental processes and the UM/PHM Plan.  
• Effective and professional communication with members, clients/providers, and collaborative departments with ability to build rapport telephonically. 

IN 12 MONTHS 

• ​​Experienced collaboration skills in reporting and cross-departmental communications. 
• In depth knowledge of the HMO product, HMO and departmental process, MSA, UM/PHM plan with associated annual expectations of change,  
• In depth knowledge of contracted IPAs with ability to cross over into each one as needed. 
• Ability to assist in departmental process creation and process improvement with ability to generate forward thinking attitude and an understanding of productivity, incentives, and departmental goals and outcomes. 

WHAT YOU'LL NEED TO HAVE 

• 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. 

• 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 home office with a door that locks for security and privacy purposes, and back-up connection service options for internet outages (this may include driving into the Rockford office on short notice). 

WOULD LOVE FOR YOU HAVE 

• Knowledge of utilization review, quality improvement, managed care, and/or community health.   
• Previous Case Management or Diabetes Care experience. 
• Previous remote and/or telephonic work experience. 
• Transportation for in-person meetings as applicable. 

WHAT YOU GET 

• Join a high performing team who brings all data into one of the top Healthcare Analytics companies in the US. 
• Learn a TON about healthcare and edge of healthcare analytics and medical economics. 
• Become an expert in clinical healthcare data. 

• Competitive compensation. 
• Great benefits like flextime time off. 
• Autonomous work environment based on trust and mutual respect with the ability of role progression and talent expansion.

COMPENSATION

Guidehealth’s compensation structure includes more than just base salary. We believe in providing world-class benefits including comprehensive medical, dental, and vision plans, long and short-term disability, life insurance, and a 401k plan with a generous match. Our paid time off program includes paid holidays and flexible time that focuses on meeting the demands of the position and our clients, while providing the balance that our employees need.

The base pay range for this role is between $65k and $75k per year paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging is at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment. 

This position is responsible for following all Security policies and procedures in order to protect all PHI under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles, the responsibilities would be further defined by the hiring manager.