Remote Manager, Case Management

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.  

Join us as we put healthcare on a better path!!  

Job Description

In this position you will lead this department in meeting their care management goals. The team is responsible for outreach to select patients identified by Blue Cross Blue Shield through ICD 10 codes, readmissions and frequency of ER visits. This role is responsible for project management and supervision of the Case Managers. and you will work to meet the Key Performance Indicators around program enrollment. 

WHAT YOU’LL BE DOING   

• Managing departmental expectations including staff hiring, orientation oversight, auditing, and reviews; time management; motivation; and performance improvement 
• Creating and monitoring of KPIs and metrics to ensure levels of service are met. 
• Serving in project management and delegation of duties to ensure coverage for all tasks 
• Prioritizing of data, tasks, and requirements. 
• Representing Guidehealth for BCBS audits with development of actions plans for each individual IPA to ensure compliance and incentive payouts 
• Overseeing all projects, 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 IPA Administrators and Client Business Managers to ensure resolution of any concerns.  
• Identifying and disseminating of Health Plan announcements applicable to Population Health 

Qualifications

WHAT YOU’LL NEED TO HAVE 

• Registered Nursing Degree from an accredited school with 5+ years management experience in a Care Management setting.  
• 5+ years of related work experience managing a dynamic, high performing team. 
• Knowledge set including: project management, team management, evidenced based practices, social determinants/barriers of health, motivational interviewing, and goal setting 
• Experience working with complex data sets 
• Healthcare data experience 

WE'D LOVE FOR YOU TO HAVE

• Experience in a fast paced, rapidly growing company.
• In depth knowledge of TPA’s, CMF’s, health plans and Medicare Advantage with ability to decipher meanings and identify changes 
• Knowledge of national guidelines and care trends/incentives, crossovers with quality, and insights to analytics  

Additional Information

The salary for this role is $95,000.00 per year.

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 Flexible Time Off tailored to meet your needs and the needs of the business, 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 comp