Remote RN Case Manager

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.  As a growing and innovative organization, we operate with a high degree of agility. Employees are expected to adapt to evolving business needs, step in to support cross-functional initiatives, and contribute beyond traditional role boundaries when needed. This collaborative and flexible mindset is essential to our success. We encourage cross-training, ongoing development, and a commitment to learning across all areas of the business—ensuring we continue to grow and you continue to thrive as a high-performing, mission-driven team.

The RN Case Manager serves as a trusted clinical partner to patients, families, providers, and interdisciplinary teams, guiding individuals through complex health journeys with compassion, clinical excellence, and purpose. This is a primarily remote position with telephonic and virtual engagement and occasional in‑person participation as program needs require. This position blends strong nursing judgment with a whole-person approach to care management, addressing medical, behavioral, and social needs to support optimal health outcomes. The RN Case Manager is responsible for assessment, care planning, coordination, monitoring, and evaluation of services for a defined population, including members with chronic, complex, and high-risk conditions. Working closely with primary care providers, patient navigators, and other care team members, the Care Manager – Registered Nurse ensures safe, effective, equitable, and patient-centered care within a value-based care model.

Clinical Care Management: Conducting comprehensive clinical, psychosocial, and functional assessments to identify patient needs, risks, and goals. Developing, implementing, and maintaining individualized, evidence‑based care plans in collaboration with patients, families, PCPs, and the interdisciplinary care team. Providing clinical interventions and nursing support aligned with care plan goals, protocols, and accreditation standards. Monitoring patient progress through ongoing outreach, data review, and reassessment; adjust care plans as indicated. Developing patient‑specific escalation plans with providers for acute but non‑emergent changes in condition. Care Coordination & Advocacy: Coordinating care across providers, settings, and services to ensure continuity, safety, and quality. Partnering with patient navigators and non‑clinical team members to address social determinants of health, including access to transportation, food, housing, and community resources. Serving as a clinical advocate, assisting patients in accessing services requiring nursing licensure, clinical expertise, or care management oversight. Facilitating referrals and follow‑up to ensure timely connection to recommended services and resources. Patient & Family Engagement: Building meaningful, trusting relationships with patients and families through empathetic, culturally responsive communication. Providing education on conditions, treatment options, self‑management strategies, and navigation of the healthcare system. Empowering patients to make informed decisions and achieve greater health autonomy. Quality, Compliance, & Documentation: Maintaining accurate, timely, and compliant documentation in electronic medical records and care management systems. Utilizing evidence‑based clinical guidelines, internal protocols, and defined quality metrics (e.g., NCQA, HEDIS). Participating in quality, utilization management, and performance improvement activities as applicable. Maintaining strict confidentiality and adhere to all regulatory, accreditation, and organizational standards.