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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 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements.

Job DescriptionDescription: MUST HAVE VALID INDIANA RN LICENSE Our Nursing Team is growing in Indiana! Great Benefits after 30 days! PTO & Holiday Pay after 90! Summary: Our Staff Nurse's are responsible for conducting patient assessments by phone (ours) to determine individual needs for incontinence supplies. Essential Functions Consults by phone with client, primary caregiver, primary care physician or specialist, case managers and other community resources to determine if client qualifies for a particular program. • Expectation is that Nurse will complete 20-25 assessments daily, on average with 98% accuracy., • Conducts clinical assessments by phone and documents the client’s medical history. Monitors success rates. All products ordered must be assessed for use and quantity needs per day., • Identifies appropriate product and quantity needs based on assessment. If formulary product will not meet needs, then reviews needs and potential solutions with Nurse Manager., • Reassesses if there is a change in a client’s medical condition or an increase in quantity request., • Obtains prior authorization from the state contract administrator for off-formulary or over-quantity requests., • Reviews letters of medical necessity to determine if client qualifies for product or quantity requested., • Reviews accounts for accuracy, reporting any errors to the appropriate department manager/leader., • Participates in after-hours emergency call rotation., • Understanding of insurance guidelines., • Utilize intranet tools to complete assessments., • Provides education to other J & B employees or external clients regarding products. Position Type This is a full time REMOTE position 40 hours per week. Monday through Friday, hours of work vary between 8:00am to 6:00pm. Occasional early mornings, evening and weekend work may be required as job duties demand. Requirements: • Current Registered Nursing License (RN) with the State of INDIANA (IN ONLY - CNL'S ARE NOT ACCEPTED), • 2+ years previous work experience demonstrating patience, compassion and strong communication skills, • 3 years of nursing experience, • Knowledge of medical terminology, • Medicare and Medicaid background Other Duties All other duties as assigned by management. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are request of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.