Manager, Clinical Care Case Management - Remote

Company DescriptionWHO 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.Job DescriptionThe Manager, Clinical Care is primarily responsible for the day-to-day operations of an integrated multi-disciplinary clinical and clinical support structure that will effectively monitor, support, and lead Value Based clinical initiatives. This includes but is not limited to case management, transitions of care, care coordination and continuity, provider/staff education on ACO/MA Plan clinical programs, and helping to build and maintain a network of community support. This individual must exhibit strong leadership, management, and interpersonal skills, as well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the organization.WHAT YOU’LL BE DOING

• Effectively managing day to day Health Plan Clinical Programs to enhance clinical efficiencies
• Identifying opportunities for increased outpatient vs. inpatient utilization
• Utilizing data provided to help in managing population health needs and implement population programs for Health Plan beneficiaries
• Executing case management for patients identified at highest risk for adverse event or exacerbation, having the ability to impact, with the goal of decreasing unnecessary emergency department visits/hospitalizations
• Overseeing an extended patient care team as assigned including but not limited to: Social Workers, Emergency Department Liaisons, Behavioral Health Liaisons, and Home Health Liaisons.
• Overseeing smooth Transitional Care Management for all patients discharged from in patient facility (hospital, skilled nursing/rehab, behavioral health) ensuring: Primary Care Provider visit, DME and Home Health Services, Specialist appointments, and community resources/social services are provided as indicated.
• Ensuring Quality Measures are reviewed and addressed when applicable/appropriate
• Implementing and directing Health Plan Health Education Activities for beneficiaries, providers, and staff
• Participating in Care Coordination and Quality Committees, Primary Care Provider Meetings, and other meetings as required
• Monitoring corporate initiatives and strategies to achieve utilization of business and financial goals
• Managing the successful integration of ACO Programs into current operations to meet the goals of all stakeholders
• Maintaining collaborative relationships with business partners both within the company and the community
• Managing and execute organizational opportunities and implement changes that are in alignment with corporate financial goals and strategic endeavors.
• Managing departmental expectations: staff hiring, orientation, auditing, and reviews; time management; motivation; and performance improvement
• Prioritizing of data, tasks, and requirements: Project management with expertise in departmental tasks and processes
• Representing for health plan audits with development of actions plans for individual clients as needed to ensure compliance and incentive payouts
• Overseeing all projects, productivity, daily tasks and PHM activities in an organized and efficient manner
• Ensuring access to EMR systems for department staff
• Monitoring staff maintenance of HIPPA regulations
• Communicating with health plan contacts, customer Administrators and Client Business Managers to ensure resolution of any concerns.
• Identifying and disseminating of Health Plan announcements applicable to Case Management

QualificationsWHAT YOU’LL NEED TO HAVE

• RN/BSN required
• 5 years of management experience
• 4 years clinical nursing experience
• At least 4 years of extensive experience in chronic care case management in outpatient setting
• Certification in case management preferred
• Must be able to work remotely and obtain state licensure in Illinois, Georgia, Pennsylvania, and Texas
• Must feel comfortable and confident leading a team of certified but unlicensed personnel and Registered Nurse case managers
• Ability to read, analyze, and interpret the most complex documents. Ability to respond effectively to the most sensitive inquiries or complaints.

Additional InformationThe salary range for this position is $110,000ALIVE with Purpose: How We Thrive at GuidehealthAt Guidehealth, our values come to life in everything we do.

• We are Driven by Accountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
• Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a better future for healthcare.
• With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
• At Guidehealth, Every Voice Matters — we believe our collective strength is rooted in the unique perspectives of each team member.
• And through Empathy in Action, we build stronger connections with those who count on us.
• This is what it means to be ALIVE with purpose. This is how we thrive — together — at Guidehealth.

BENEFITS:All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• 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.

COMPENSATION:The listed compensation range listed is 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 EMPLOYMENTDiversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATAThis position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.REMOTE WORK TECHNICAL REQUIREMENTSGuidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test to confirm your internet connection meets these requirements.
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