RN Case Manager – Behavioral Health

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🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 11%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Guide Healthcare

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2018

⚕️ Healthcare Insurance

🏥 Healthcare

🎯 Recruiter

Healthcare Insurance • Healthcare • Recruitment

Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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