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Job DescriptionCompany Description WHO IS GUIDEHEALTH? Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. Join us as we put healthcare on a better path!! Job Description As a registered nurse with an Illinois nursing license, you will work remotely 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, NCQA 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 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. Qualifications 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., • 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, 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., • Certification in Case Management preferred but not required Additional Information The salary range for this role is between $80,000.00 and $85,000.00 ALIVE with Purpose: How We Thrive at Guidehealth At Guidehealth, our values come to life in everything we do. • We are Driven by Accountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike., • Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a better future for healthcare., • With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve., • At Guidehealth, Every Voice Matters — we believe our collective strength is rooted in the unique perspectives of each team member., • And through Empathy in Action, we build stronger connections with those who count on us. All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include: • Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs., • Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered., • Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution., • Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected., • Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times., • Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals., • Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need. The listed compensation range listed is 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 are 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, physical, sensory, or medical 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. OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA This position is responsible for following all Security policies and procedures in order to protect all PHI and PII 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. REMOTE WORK TECHNICAL REQUIREMENTS Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.

Job DescriptionDescription: Nurses – are you looking for a change? Want to work no nights, no weekends, and no holidays? Be able to work from home 50% of the time once trained? Check out Hines & Associates! ABOUT US: Hines is a nationwide, independent leader in personalized managed health care, focused on what’s important to you—comprehensive services with the program excellence and cost containment that you demand. Hines & Associates, Inc.’s reputation as an industry leader is founded on over three decades of innovative and professional health care excellence. Serving all aspects of the industry, Hines is committed to conserving health care dollars while ensuring quality care through effective programs and personalized service. WHAT WE OFFER: • Competitive salary and benefits, including medical, dental, vision, long-term care, short-term disability, long-term disability, company paid and voluntary life insurance. Critical Illness, accident insurance and flexible spending also available!, • 401k plan with company match, fully vested after 1 year., • No weekends and nights!, • Paid Holidays, • Work-life balance. This individual will utilize clinical knowledge and communication skills to obtain patient specific information regarding patient condition and proposed treatments and procedures to determine if illness and/or proposed services meet acceptable criteria sets and acceptable nursing practice guidelines for outpatient treatment or inpatient confinement. This individual will certify treatment for confinement when criteria and/or practice guidelines are met, in accordance with the health benefit plan, disability, workers compensation regulations and state and federal regulations. If these conditions do not appear to be met, this individual will defer decision to a second level reviewer. This individual interfaces with case managers and disease management nurses on active cases involved in other Hines’ programs. * RESPONSIBILITIES AND PERFORMANCE: • Completes first level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review. General Medical-Surgical nursing is sufficient to be relevant to the clinical areas addressed in most initial clinical reviews. ., • Demonstrates ability to assess a patient’s current medical status, including complications and untoward events, which may require additional intervention. Provides certification of medical, disability and workers compensation cases., • Demonstrates a thorough understanding of criteria sets and their limitations including when a second level review is required., • Evaluates appropriateness of current plan of care., • Assesses aftercare needs, implements discharge planning and/or case management referral in a timely manner., • Maintains knowledge of current advances and trends in medical care., • Demonstrates knowledge of URAC guidelines, Hines policies and procedures, and standards of practice and their revisions. Able to attain and maintain the minimal quality assurance performance standards., • Demonstrates assertiveness in completion of precertification and concurrent review within the guidelines of URAC, disability, workers compensation regulations, and state and federal requirements and according to the Hines policies and procedures., • Performs onsite evaluations as needed or requested., • Communicates with hospital staff, physicians, other providers and Hines customer contacts in a competent, calm, effective and professional manner., • Effectively communicates the need to refer to a higher-level review for questionable plans of treatment., • Provides written documentation concerning the clinical information obtained regarding the patient’s status, benefit and claim concerns, and validation of criteria., • Participates in self-evaluation by identifying areas of strength and limitations and offers and accepts constructive criticism., • Creative and assertive., • Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the United States where employed. For mental health/substance abuse, licensed medical professional with an unrestricted license in the state or in a state that has licensure reciprocation with the state of the office location the employee is working in may perform first level reviews. Accepted licensure includes but is not limited to RN, LMSW, LMHC., • Successful completion of UR nurse orientation program., • Minimum of 3 years recent acute clinical practice required, 5 years preferred., • Managed care, disability or workers compensation experience helpful but not mandatory. Compensation details: 57244-62180 Yearly Salary PIcc5888357fb4-25405-34548457

Provides written documentation concerning the clinical information obtained regarding the patient’s status, benefit and claim concerns, and validation of criteria. Remote/hybrid setting (once trained). Accepted licensure includes but is not limited to RN, LMSW, LMHC.

Provides written documentation concerning the clinical information obtained regarding the patient’s status, benefit and claim concerns, and validation of criteria. Remote/hybrid setting (once trained). Accepted licensure includes but is not limited to RN, LMSW, LMHC.

Click here to learn more about benefits and the total rewards at OSF. RN experience, 2-year work commitment. RN experience, 2-year work commitment.

Cardiovascular Intensive Care Unit Nurses, or CVICU RNs, provide critical care to patients with potentially life-threatening heart conditions.

The RN must be highly knowledgeable and possess strong nursing skills necessary to provide excellent patient care that is appropriate to the ages of the patients served within their RN specialty. Click here to learn more about benefits and the total rewards at OSF. Sign on bonus eligible! Internal M

Shift Options: Part Time Mornings 7am-3pm/ Part Time Overnight 11pm-7:30am / Part Time Evenings 3pm-11pm. Registered Nurse (RN) Signing Bonus at Franciscan Ministries summary:. Position: RN – Registered Nurse.

POSITION SUMMARY: The Burn Coordinator is responsible for maintaining the Burn Registry, Report Writing, Performance Improvement, Quality Assurance. Responsible for compliance with all applicable governmental and specialty regulatory agencies including disaster planning, and American Burn Associatio

St Croix Hospice is hiring an On Call RN for our Rockford IL branch.

AHS Staffing is seeking a travel nurse RN NICU - Neonatal Intensive Care for a travel nursing job in Lew Lenox, Illinois. Job Description & Requirements ~ Specialty: NICU - Neonatal Intensive Care ~ Discipline: RN ~ Start Date: 02/10/2025 ~ Duration: 13 weeks ~36 hours per week ~ Shift: 12 ho

Click here to learn more about benefits and the total rewards at OSF. The RN Hospital Inpatient/ED operates in units that provide 24/7 care in the hospital. Experience: Experience as an RN in a healthcare environment.

Full Time (8, 12 or 14 weeks, with a maximum of 36 total weeks); 8 hour rotating shifts & will include rotating weekends.Various health insurance options & wellness plans.Retirement benefits including employer match plans.Long-term & short-term disability.Employee assistance programs (EAP).Parental

Job Description & Requirements ~ Specialty: NICU - Neonatal Intensive Care ~ Discipline: RN ~ Start Date: 02/10/2025 ~ Duration: 13 weeks ~36 hours per week ~ Shift: 12 hours, nights ~ Employment Type: Travel Must be comfortable with: neonatal vents, vapotherm or cpap, neonatal IV, lines

Shift Options: Part Time Mornings 7am-3pm/ Part Time Overnight 11pm-7:30am / Part Time Evenings 3pm-11pm. Current unrestricted license as a Registered Nurse (RN) in practicing state. Welcomes suggestions and new ideas as an opportunity to learn, grow and improve.

Click here to learn more about benefits and the total rewards at OSF. The RN Hospital Inpatient/ED operates in units that provide 24/7 care in the hospital. Experience: Experience as an RN in a healthcare environment.

Full Time (8, 12 or 14 weeks, with a maximum of 36 total weeks); 8 hour rotating shifts & will include rotating weekends.Various health insurance options & wellness plans.Retirement benefits including employer match plans.Long-term & short-term disability.Employee assistance programs (EAP).Parental

Click here to learn more about benefits and the total rewards at OSF. The RN Hospital Inpatient/ED operates in units that provide 24/7 care in the hospital. PREFERRED QUALIFICATIONS: Education: BSN Experience: Experience as an RN in a healthcare environment Other skills/knowledge: Electronic Medical

New $25,000 Sign-On Bonus for Full Time Night shift RNs!!. Current RN license in the state you will be working.

PREFERRED QUALIFICATIONS: Education: BSN Experience: Experience as an RN in a healthcare environment Other skills/knowledge: Electronic Medical Record and Microsoft application basic proficiency. Click here to learn more about benefits and the total rewards at OSF. The RN Hospital Inpatient/ED opera

St Croix Hospice is hiring an On Call RN for our Rockford IL branch.

Interpersonal skills to effectively communicate with healthcare providers and hospital management, both internally and externally (region-wide). POSITION SUMMARY: The Burn Coordinator is responsible for maintaining the Burn Registry, Report Writing, Performance Improvement, Quality Assurance. Respon

Neonatal Intensive Care Nurses care for premature and critically ill newborns in the neonatal intensive care unit (NICU) of a hospital. These babies are born needing immediate medical attention, so Neonatal Intensive Care Nurses connect them to technology that helps them breathe and allows them to b

New $25,000 Sign-On Bonus for Full Time Night shift RNs!!. Current RN license in the state you will be working.

Travel Registered Nurse RN Long Term Acute Care LTAC at OneStaffMedical summary:. The Travel Registered Nurse RN in Long Term Acute Care LTAC provides essential healthcare services to patients with disabilities or illnesses requiring extended care.

AHS Staffing is seeking a travel nurse RN NICU - Neonatal Intensive Care for a travel nursing job in Lew Lenox, Illinois. Job Description & Requirements ~ Specialty: NICU - Neonatal Intensive Care ~ Discipline: RN ~ Start Date: 02/10/2025 ~ Duration: 13 weeks ~36 hours per week ~ Shift: 12 ho

Neonatal Intensive Care Nurses care for premature and critically ill newborns in the neonatal intensive care unit (NICU) of a hospital. These babies are born needing immediate medical attention, so Neonatal Intensive Care Nurses connect them to technology that helps them breathe and allows them to b

The RN must be highly knowledgeable and possess strong nursing skills necessary to provide excellent patient care that is appropriate to the ages of the patients served within their RN specialty. RN Experience = No weekend Shifts. Home Health RNs must have own transportation, auto insurance and abid

Travel Registered Nurse RN Long Term Acute Care LTAC at OneStaffMedical summary:. The Travel Registered Nurse RN in Long Term Acute Care LTAC provides essential healthcare services to patients with disabilities or illnesses requiring extended care.

POSITION SUMMARY: The RN Med/Surg Clinical Resource Team (CRT) Float Pool provides the highest level of expert RNs to care for patients throughout the inpatient stay within OSF HealthCare. The RN must be highly knowledgeable and possess strong nursing skills necessary to provide excellent patient ca

AHS Staffing is seeking a travel nurse RN NICU - Neonatal Intensive Care for a travel nursing job in Lew Lenox, Illinois. Job Description & Requirements ~ Specialty: NICU - Neonatal Intensive Care ~ Discipline: RN ~ Start Date: 02/10/2025 ~ Duration: 13 weeks ~36 hours per week ~ Shift: 12 ho

The RN must be highly knowledgeable and possess strong nursing skills necessary to provide excellent patient care that is appropriate to the ages of the patients served within their RN specialty. POSITION SUMMARY: The RN Med/Surg Clinical Resource Team (CRT) Float Pool provides the highest level of

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

The RN Hospital Inpatient/ED operates in units that provide 24/7 care in the hospital. Experience: Experience as an RN in a healthcare environment. Click here to learn more about benefits and the total rewards at OSF.

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

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An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

Cardiovascular Intensive Care Unit Nurses, or CVICU RNs, provide critical care to patients with potentially life-threatening heart conditions.

What do we do? Medical Solutions is one of the nation’s largest providers of total workforce solutions in the healthcare industry, connecting nurses and allied health clinicians with hospitals and healthcare systems across the country and around the corner. Medical Solutions Direct Hire is seeking

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

Excite Health Partners is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Matoon, Illinois. Specialty: ICU - Intensive Care Unit ~ Discipline: RN ~ Shift: 12 hours, nights ~ Employment Type: Travel Excite Health Partners Job ID #186706. We take the time to con

Discipline: RN ~ Start Date: ASAP ~ Shift: 10 hours, days ~ Employment Type: Travel Registered Nurse Operating Room - CVOR When you're on assignment with us, you'll get access to industry-leading benefits, including comprehensive medical coverage, 401(k) matching, competitive pay packages

Medical Solutions Direct Hire is seeking a Registered Nurse (RN) Manager, OR - Operating Room for a nursing job in Rockford, Illinois. What do we do? Medical Solutions is one of the nation’s largest providers of total workforce solutions in the healthcare industry, connecting nurses and allied hea

AHS Staffing is seeking a travel nurse RN CVOR for a travel nursing job in Rockford, Illinois. Discipline: RN ~ Start Date: ASAP ~ Shift: 10 hours, days ~ Employment Type: Travel Registered Nurse Operating Room - CVOR When you're on assignment with us, you'll get access to industry-leadin

Our supportive environment includes: * A comprehensive onboarding program * Clinical educators, preceptors, and supervisors to mentor and guide * Up to 90% off higher education (degrees, certifications) and test preparation for you and your family * Dedicated schedulers to support flexible scheduli

Leading with Heart: Your Journey Starts Here Seeking a career that's both personally enriching and professionally rewarding, close to home? Encompass Health invites you into a welcoming space that feels like family, where your worth is embraced, fostering connections akin to lifelong friendsh

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidates to tr

Youll use your specialized skills to provide high-quality, compassionate, individualized care for our patients, allowing you time to get to know them and help them achieve their goals during their rehabilitation journey. Be the Registered Nurse youve always wanted to be: Help patients by supervising