RN Case Manager – Behavioral Health

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🕒 Setembro 1

🌽 Illinois – Remoto

🌽 Illinois – Remote

💵 $90.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 16%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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Guide Healthcare

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 2018

⚕️ Seguro de Saúde

🏥 Saúde

🎯 Recrutamento

Healthcare Insurance • Healthcare • Recruitment

A Guide Healthcare está liderando um movimento onde a criatividade gera mudanças positivas no setor de saúde. A empresa é especializada na prestação de serviços de saúde aliados e recrutamento na área de saúde, com foco no suporte e tratamento de idosos. Com um compromisso de agregar valor aos seus clientes, parceiros e equipes, a Guide Healthcare busca fazer as coisas de maneira diferente na indústria.

Descrição

• Enhance the quality of member management and maximize member satisfaction and cost effectiveness • Assist members in navigating the healthcare system as a collaborative health partner • Promote wellness, problem-solve, and help members achieve personal healthcare goals • Conduct telephonic member and provider outreach • Collect, analyze, and report data • Perform clinical reviews and medical and behavioral health assessments • Document work in compliance with federal and state regulations, NCQA standards, and company policies • Pull, sort, and analyze data to determine member eligibility for the Population Health Management Program • Coordinate and provide timely, effective, equitable, safe, and member-centric care following HMO processes • Manage case assignments, including outreach, documentation, progression monitoring, and case closure • Meet reporting and documentation standards and participate in collaborative meetings with department staff and clients • Address barriers, social determinants, member motivators, and psychosocial issues • Educate members on navigating the HMO and healthcare spectrum • Promote quality and cost-effective interventions and outcomes • Support operational aspects of the division to meet customer requirements and satisfaction • Maintain confidentiality of computer programs, medical records, and data • Participate in QM/UM Committee meetings, including material preparation, minutes, data collection and analysis, reporting, and follow-up • Participate in off-hour/weekend call rotation if applicable • Maintain continued professional growth and education consistent with current nursing practice and the Illinois Practice Act • Perform other assigned responsibilities and meet changing annual program requirements

🎯 Requisitos

• Current Illinois Registered Nurse License • Illinois nursing professionals must complete 20 hours of continuing education per 2-year license renewal cycle • Minimum 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 • Experience with motivational interviewing • Excellent clinical judgment • Highly skilled in verbal and written communication • Strong organizational, problem-solving, and time-management skills • Ability to complete projects and assignments on time • Ability to prioritize and react to rapidly changing business needs • Ability to work independently and remotely while multitasking in fast-paced workflows • Proficiency with word processing, spreadsheets, MS Word, Excel, Access, PDF, and Outlook • Experience navigating multiple EMR systems • High-speed, secure home internet connection with minimum 100 Mbps download and 10 Mbps upload • Private HIPAA-compliant home office with a locking door • Backup internet connection service options • Certification in Case Management preferred but not required • Must be accessible during stated working hours • Must disclose any secondary employment

🏖️ Benefícios

• Fully remote work arrangement • Comprehensive medical, dental, and vision plans • 401(k) plan with a 3% employer match to the employee’s 6% contribution • Life and disability insurance • Voluntary life insurance options • Employee Assistance Program (EAP) • Paid time off plans • Paid parental leave • Learning and development resources • Necessary work equipment provided at no charge • Flexible work arrangement reducing commuting time