RN Case Manager – Behavioral Health

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🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – 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, maximize member satisfaction and cost effectiveness, and assist members in navigating the healthcare system • Work collaboratively with clients, members, and healthcare teams to promote wellness and problem-solve • Conduct telephonic member and provider outreach • Collect and analyze data • Perform reporting, clinical review, medical and behavioral health assessments, and compliant documentation • 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 while following HMO processes • Manage case assignments, including outreach, documentation, monitoring case progression, 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 to support wellness and health autonomy • Educate members on navigating the HMO and healthcare spectrum while promoting quality and cost-effective interventions and outcomes • Support operational activities 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 tasks; some meetings may require in-person attendance • Rotate in off-hour/weekend calls if applicable • Pursue continued professional growth and education consistent with current nursing practice and the Illinois Practice Act • Perform other responsibilities as assigned and according to annual program requirements

🎯 Requirements

• Current IL Registered Nurse License • Illinois nursing professional staff must complete 20 hours of continuing education per 2-year license renewal cycle • Minimum of 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 ensure timely completion of projects and assignments • Ability to prioritize and react to rapidly changing business needs • Ability to work independently and remotely with multi-tasking skills for fast-paced workflows • Software knowledge including word processing and spreadsheets • Computer skills including MS Word, Excel, Access, PDF, Outlook, etc. • Experience navigating multiple EMRs • High-speed/secured home internet connection with minimum 100 Mbps download and 10 Mbps upload • Private HIPAA-compliant home office with a locking door for security and privacy • Backup internet connection service options for outages

🏖️ Benefits

• Fully remote work with flexible work-from-home arrangement • Necessary work equipment provided at no charge • 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 • Virtual meetings and remote-first work environment