Clinical Care Manager, Rn - Chicago, United States - Guidehealth

Guidehealth

Verified Company

Chicago, United States

2 days ago

Posted by:

Mark Lane

beBee recruiter

Description

WHO IS GUIDEHEALTH?

At Guidehealth, our mission is to enhance healthcare affordability for patients and restore the fulfillment of practicing medicine for providers.

As a physician-led company, we recognize that streamlining administrative tasks and harnessing the power of predictive analytics and AI enable our partner physician practices to prioritize delivering high-quality healthcare focused on outcomes and value.

Driven by empathy, we empower physicians to anticipate the needs of patients requiring more attention, strengthen connections between patients and physicians with virtually-embedded Healthguides, and leverage AI and analytics to proactively avoid preventable events.

This approach results in increased levels of patient and practice engagement, ultimately leading to more significant positive impacts on patients.

Join us as we put healthcare on a better path

In this position you will be working with a team of independent and autonomous nurses to break down barriers and ensure quality and timely care.

WHAT YOU'LL BE DOING

Performing utilization review services in compliance with federal and state regulations, and the URAC standards for client members seeking healthcare treatment and services.
Obtaining, analyze and document all supporting clinical within the documentation record.
Completing a timely review of health care services utilizing and documenting the appropriate medical criteria used to make a clinical determination.
Completing timely written and / or verbal communication of precertifications and concurrent review determinations for healthcare services to all parties required by regulations, URAC standards and Guidehealth policies.
Communicating with the Medical Director and Peer Reviewer(s) for cases requiring review of medical necessity, appropriate treatment, intensity/ number of inpatient and outpatient treatment or quality of care issues.
Interfacing with ordering providers and provider organizations on a routine basis. In some instances, communication with members or their representatives may be appropriate.
Initiating the referral of targeted patients into organized disease management programs to assist with continuity and quality of care.
Managing and documenting afterhours phone calls from members and providers on a rotational basis
Maintaining confidentiality of member information, case records and file entries
Participating in quality management activities
Responsible for sending client specific benefit exhaustion letters upon request.
Assisting with coordination and the design and development of clinical and client specific reports.
May assist in the development of materials and packets for the QM/ UM Committee meetings, the documentation of minutes, preparation of spreadsheets, data collection and analysis, and followup tasks.
Maintaining current knowledge and comply with regulatory requirements for multiple jurisdictions and medical groups
Integrating ongoing, accurate knowledge of medical group guidelines and URAC standards into daily duties
Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Nurse Practice Act.
Interacting with the IT Department for technical support related to computer systems, upgrades and other data

WHAT YOU'LL NEED TO HAVE

Registered Nurse with an active and unrestricted License.
Five years of experience in a variety of health care settings.
Knowledge of utilization review, managed care and community health.
Computer skills including MS Word, Excel, MS Access, etc.
Strong organizational, writing and speaking skills necessary.
Ability to prioritize and react based on rapidly changing business needs.
Excellent clinical judgment, compassion and a positive attitude

WOULD LOVE FOR YOU HAVE

An advanced degree or certification in Case Management, Utilization Review and/or Quality
Interest in Informatics
Knowledge in Population Health and Disparities

COMPENSATION
Guidehealth's compensation structure includes more than just base salary.

We believe in providing world-class benefits including comprehensive medical, dental, and vision plans, long and short-term disability, life insurance, and a 401k plan with a generous match.

Our paid time off program includes paid holidays and flexible time that focuses on meeting the demands of the position and our clients, while providing the balance that our employees need.

The base pay range for this role is between $70,000.00 to $75,000.00 per year 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 is at the core of Guidehealth's values. W