Remote Clinical Care Manager

Overview

The Remote Clinical Care Manager at Guidehealth is responsible for performing utilization review services, ensuring compliance with regulations, and maintaining communication with healthcare providers and patients.

In Short

• Perform utilization review services in compliance with regulations.
• Analyze and document clinical information.
• Communicate pre-certifications and review determinations.
• Interface with medical directors and providers.
• Manage after-hours calls from members and providers.
• Participate in quality management activities.
• Maintain confidentiality of member information.
• Assist in the development of clinical reports.
• Stay updated on regulatory requirements.
• Interact with IT for technical support.

Requirements

• Active Registered Nurse license in Illinois.
• Five years of healthcare experience.
• Knowledge of utilization review and managed care.
• Proficient in MS Word, Excel, and Access.
• Strong organizational and communication skills.
• Ability to prioritize in a fast-paced environment.
• Excellent clinical judgment and compassion.

Benefits

• Fully remote work environment.
• Comprehensive medical, dental, and vision plans.
• 401(k) plan with employer match.
• Life and disability insurance.
• Flexible time off policy.
• Paid parental leave.
• Professional growth and development resources.