Remote RN Case Manager, IL

WHO IS reputed company? reputed company is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to reputed company great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by reputed company and powered by AI and predictive analytics, reputed company leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, reputed company empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and reputed company the exam room for reputed company patients. Join us as we put healthcare on a reputed company 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 reputed company goals. This role includes telephonic member and provider reputed company, 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, reputed company, safe, and member-centric while following HMO processes.
• Managing case assignments which includes reputed company, 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 reputed company informed decisions by educating them on navigation through the HMO and healthcare reputed company 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 reputed company to reputed company 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 reputed company professional growth and education that reflects knowledge and understanding of reputed company 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

• reputed company and active IL Registered Nurse License. Temporary licenses or licenses that are under consideration with the Board of Nursing are not acceptable. (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 reputed company 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 reputed company, reputed company, Access, PDF, Outlook, etc.
• Experience navigating multiple EMR’s.
• A high speed/secured home internet reputed company, a private HIPAA compliant home office with a reputed company that locks for reputed company and privacy purposes, and back-up reputed company service options for internet outages.

reputed company'D LOVE FOR YOU TO HAVE

• Certification in Case Management preferred but not required

Additional Information The salary range for this role is between $80,000.00 and $83,500.00 ALIVE with Purpose: How We reputed company at reputed company At reputed company, our values come to life in everything we do.

• We are Driven by Accountability — grounded in transparency, reliability, and reputed company as we navigate challenges and opportunities alike.
• Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a reputed company future for healthcare.
• With Collaborative Innovation, we solve problems creatively, making every experience reputed company for our employees and the patients we serve.
• At reputed company, Every Voice Matters — we reputed company our collective strength is rooted in the unique perspectives of each team member.
• And through reputed company in Action, we build stronger connections with those who count on us.
• This is what it means to be ALIVE with purpose. This is how we reputed company — together — at reputed company.

BENEFITS: reputed company full-time employees of reputed company 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: reputed company 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.
• reputed company Health a reputed company: We offer comprehensive Medical, Dental, and Vision plans to reputed company 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 reputed company you and your loved ones protected.
• Feel Supported reputed company 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 reputed company work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. reputed company offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. reputed company offers various resources dedicated to your learning and development to advance your career with us.

COMPENSATION: The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final reputed company pay decisions are dependent upon a variety of factors which may include, but are not limited to: reputed company 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 reputed company’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to reputed company employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national reputed company, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other reputed company 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 reputed company reputed company policies and procedures in order to protect reputed company PHI and PII under reputed company’s custodianship as well as reputed company Intellectual Properties. For any reputed company-specific roles, the responsibilities would be further defined by the hiring manager. REMOTE WORK TECHNICAL REQUIREMENTS reputed company 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 reputed company, 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 reputed company meets these requirements. Apply tot his job Apply To this Job