Part-time RN Case Manager (Remote)

Company Description

WHO IS GUIDEHEALTH? 

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. 

This position is fully remote but we look for candidates that ideally can work on CST time zone. 

Job Description

 The Nurse Case Manager is responsible for conducting patient outreach to Improve Healthcare Effectiveness Data and Information Set (HEDIS) measure compliance. This role involves coordinating care, educating patients, and working closely with providers on closing care gaps. The Nurse Case Manager ensures patients receive necessary screenings, immunizations, and chronic disease management to enhance quality outcomes and optimize HEDIS performance.

WHAT YOU’LL BE DOING  

• Educate patients on the importance of preventative care, screenings, and disease management with a focus on recent discharge, acute care utilization, and CHF.
• Identify and address barriers to care, including SDOH, and assist with referrals to appropriate resources.
• Coordinate with providers, care teams, and quality improvement team to coordinate patient care and close gaps.
• Document patient interaction, outreach efforts, and interventions in electronic health records and case management platform.
• Assist with developing and implementing patient-centered strategies to improve HEDIS measure performance.
• Participate in training, team meetings, and quality improvement initiatives to enhance program effectiveness.
• 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.
• Utilizing evidence-based clinical protocols and guidelines along with defined quality metrics.
• Occasional evening and Saturday shifts

Qualifications

WHAT YOU’LL NEED TO HAVE

• Licensed Registered Nurse in good standing in the State of Louisiana or Compact license.
• 3+ years of RN Case Management experience. 
• Bilingual skills (English, Creole or French) are a plus.
• Excellent written and 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.
• Familiarity with HEDIS measures, care guidelines, …