Job Description

As an RN Case Manager you will be partnering with clinical teams to provide complex case management and strengthen the connection between the patient and the primary care physician/medical practice staff. The Registered Nurse (RN) Case Manager is responsible for assisting patients to achieve their highest-level wellness. You will be Case Managing a specific patient population which includes complex medical conditions, social-economic and/or mental health co-morbidities. The RN Case Manager will optimize the patient’s health status through assessment, planning, implementation, coordination, monitoring, and evaluation of the options and services available to the patient. The RN Case Manager will collaborate with approximately 5 patient care navigators and other members of a patient’s care team to achieve optimal quality, clinical, and financial outcomes.

This is a fully remote position supporting clients in the eastern time zone. We have a strong preference for candidates living in the Eastern or Central time zone.

WHAT YOU’LL BE DOING

• Comprehensively assessing the healthcare and psychosocial needs of patients
• Reviewing and amending patient navigator interviews with the patient.
• Developing, implementing, and maintaining individualized care plans in accordance with all internal protocols and accreditation standards.
• Providing evidence-based clinical interventions based upon the individualized care plan goals.
• Partnering with patient navigator to manage non-clinical elements of care plan, such as making appointments, arranging transportation or food services, or other SDOH/non-medical patient needs.
• Providing ongoing outreach to patients, continuously monitoring patient data and adjusting plan of care accordingly.
• Developing with the PCP, patient specific escalation plans in the event of an acute, but non-emergent, exacerbation of key chronic conditions.
• Providing education regarding conditions and treatment options.
• Serving as an advocate for the patient and assist with accessing and engaging with services/resources that require clinical licensing, training, or knowledge.
• Following up on service or resource referrals
• Maintaining up to date documentation in the electronic medical health record as defined by protocol.
• Utilizing evidence-based clinical protocols and guidelines along with defined quality metrics

Qualifications

WHAT YOU'LL NEED TO HAVE

• Bilingual - Korean/English required
• Licensed Registered Nurse in good standing
• 3+ years of RN Case Management experience in outpatient setting
• CCM certification preferred, must obtain CCM within 1 year of employment
• Supervisory experience preferred
• Excellent written an oral communication skills to empathetically interact with patients, families, and the interdisciplinary team
• Excellent computer skills including the ability to learn multiple EMR and Case Management documentation systems.
• Ability to meet accreditation and quality standards including but not limited to NCQA and HEDIS

Additional Information

The salary range for this role is between $80k to 88k.

BENEFITS:

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 Flexible Time Off tailored to meet your needs and the needs of the business, 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.
• Learn and Grow: Your professional growth is important to us. Guidehealth 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 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.