RN Case Manager

📋 Description

• Conducting comprehensive telephonic evaluations to assess each patient’s medical, psychosocial, and social requirements.

• Reviewing and revising medical histories, including current medications, chronic ailments, and preventive care measures.

• Creating personalized care plans and guiding patients towards their treatment objectives and care alternatives.

• Offering compassionate, evidence-based education regarding chronic disease management and preventive health strategies.

• Tracking progress through phone check-ins, modifying care plans as necessary, and ensuring patients remain connected to their healthcare providers.

• Completing Medicare Annual Wellness Visits (AWVs) via telehealth under physician oversight.

• Collaborating with Healthguides who assist with non-clinical needs like scheduling, transportation, food support, and social determinants of health resources.

• Engaging in proactive outreach and timely follow-ups to ensure continuity of care and enhance patient engagement.

• Advocating for patients, aiding them in accessing appropriate resources when needed.

• Accurately documenting interactions in the EHR and care-management systems throughout and after calls.

• Supporting quality outcomes (HEDIS, NCQA) by coordinating preventive services and managing chronic conditions.

• Participating in virtual meetings, continuous education, and clinical training to remain up-to-date with care standards.

• Utilizing various communication methods (phone, text, patient portals, email, AI-supported tools) to engage high-risk patients.

• Collaborating in AI-driven outreach initiatives aimed at connecting with at-risk populations.

• Ensuring patient privacy in a secure, private home workspace.

• Performing additional duties as necessary to support patients and the care team.

⛳️ Requirements

• Licensed Registered Nurse in good standing in the State of Georgia with a compact license.

• 3+ years of RN Case Management experience in an outpatient environment.

• Bachelor of Science in Nursing is preferred.

• Certification in Case Management is preferred.

• Strong problem-solving abilities to identify, troubleshoot, and overcome barriers to patient care, workflows, and care plan advancement.

• Capability to analyze complex healthcare issues and implement effective solutions while ensuring compliance in a highly regulated healthcare setting.

• Ability to juggle multiple priorities, adhere to deadlines, and work independently in a fast-paced environment, guaranteeing timely and efficient case management.

• Exceptional written, visual, and verbal communication skills.

• Ability to engage in virtual meetings with clear verbal communication, effectively collaborating with healthcare teams, patients, and stakeholders.

• Outstanding conversational skills and the ability to accurately document patient interviews, utilizing software in real-time.

• Strong interpersonal skills with an emphasis on empathy, patience, professionalism, and respect in all interactions with patients, teams, and clients.

• Proven competency in independently navigating technology across multiple platforms, computer screens, and other technical components (e.g., Electronic Medical Records, care management analytics databases, phone dialing systems, Microsoft Office).

• Ability to meet accreditation and quality standards, including but not limited to NCQA and HEDIS.

• Commitment to maintaining patient confidentiality through the use of the provided headset during all conversations in a private home office without distraction.

• Adherence to all Guidehealth policies and procedures.

🏝️ Benefits

• Work from Home: Guidehealth is a fully remote organization, allowing you to minimize commuting time and focus more on your professional aspirations and personal needs.

• Keep Health a Priority: We provide comprehensive Medical, Dental, and Vision insurance plans to ensure you are well-covered.

• Plan for the Future: Our 401(k) plan includes a 3% employer match on your 6% contribution.

• Have Peace of Mind: We offer Life and Disability insurance for those unexpected moments. Additionally, voluntary Life options are available to protect you and your loved ones.

• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is available to support you during challenging times.

• Take Time for Yourself: We provide paid time off plans to help you achieve a healthy work-life balance and meet your personal goals.

• Support Your New Family: Guidehealth offers paid parental leave to ensure you have the necessary time off.

• Learn and Grow: Your professional development is important to us. Guidehealth provides various resources dedicated to your learning and advancement within the company.