Quality System Manager
Revvity
RN Case Manager
Guide Healthcare
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇮🇳 India
Visit company websiteSalary
💰 $80,000 - $85,000 per year
Job Level
Mid-LevelSenior
Tech Stack
React
About the role
- 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.
Requirements
- 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.
- A high speed/secured home internet connection, a private HIPAA compliant home office with a door that locks for security and privacy purposes, and back-up connection service options for internet outages.
Benefits
- 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: 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.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
case managementchronic condition managementutilization reviewquality improvementhealthcare managementmotivational interviewingdata analysismember eligibility determinationdocumentation standardshealth autonomy
Soft skills
clinical judgmentverbal communicationwritten communicationorganizational skillsproblem solvingtime managementindependent workmulti-taskingadaptabilitycollaboration
Certifications
IL Registered Nurse Licensecontinuing education (CE) requirements
