RN Case Manager

Role Overview

• Conducting in-depth telephonic assessments to understand each patient’s medical, psychosocial, and social needs.
• Reviewing and updating medical histories—including medications, chronic conditions, and preventive care.
• Developing individualized care plans and guiding patients through their treatment goals and care options.
• Providing empathetic, evidence-based education on chronic disease management and preventive health.
• Monitoring progress by phone, adjusting care plans, and ensuring patients stay connected to their providers.
• Completing Medicare Annual Wellness Visits (AWVs) via telehealth under physician supervision.
• Partnering with Healthguides who support non-clinical needs like scheduling, transportation, food assistance, and SDOH resources.
• Performing proactive outreach and timely follow-ups to maintain continuity of care and patient engagement.
• Advocating for patients, helping them access the right resources at the right time.
• Documenting clearly and accurately in the EHR and care-management systems during and after calls.
• Supporting quality outcomes (HEDIS, NCQA) by coordinating preventive services and managing chronic conditions.
• Participating in virtual meetings, ongoing education, and clinical training to stay current with care standards.
• Using multiple communication methods (phone, text, patient portals, email, AI-supported tools) to reach high-risk patients.
• Collaborating in AI-driven outreach programs that help connect with vulnerable populations.
• Protecting patient privacy in a secure, private home workspace.
• Performing additional responsibilities as needed to support patients and the care team.

Requirements

• Active Compact Registered Nurse license in good standing is required.
• 3+ years of RN Case Management experience, preferably in outpatient or ambulatory care.
• Strong critical-thinking and problem-solving skills to anticipate barriers and drive care forward.
• Ability to work independently, manage multiple priorities, and make sound clinical decisions remotely.
• Outstanding communication—warm, clear, confident, and patient-focused.
• Excellent telephonic interviewing skills and the ability to document accurately in real time.
• High comfort level with technology: EMRs, care-management systems, multi-screen workflow, Microsoft Office, and telecommunication tools.
• Understanding of accreditation and quality standards (NCQA, HEDIS).
• A quiet, private home office suitable for patient calls and handling PHI.
• Alignment with Guidehealth policies, clinical protocols, and compliance standards.

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: 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.