RN Case Manager, Complex Pediatric Specialty – Remote

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 Health guides™ 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

Helping patients feel supported, heard, and guided—right from your home.

At Guidehealth, we’re transforming how patients experience healthcare by combining clinical expertise with compassionate, person-centered support. As a Remote RN Case Manager, you’ll build trusted relationships with patients by phone, helping them navigate complex health needs, understand their care plans, and improve their overall well-being.

If you’re a nurse who loves making a direct impact—without the physical demands of bedside care—this role offers the meaningful patient connection you’re looking for.

This is a primarily remote role with 10–15% local travel to clinical sites in your hiring area.

• Conducting in-depth telephonic assessments to understand each patient’s medical, psychosocial, and social needs.
• Reviewing and updating medical histories—including medications, chronic conditions, and preventive care.
• Developing individualized care plans and guiding patients through their treatment goals and care options.
• Providing empathetic, evidence-based education on chronic disease management and preventive health.
• Monitoring progress by phone, adjusting care plans, and ensuring patients stay connected to their providers.
• Completing Medicare Annual Wellness Visits (AWVs) via telehealth under physician supervision.
• Partnering with Health guides who support non-clinical needs like scheduling, transportation, food assistance, and SDOH resources.
• Performing proactive outreach and timely follow-ups to maintain continuity of care and patient engagement.
• Advocating for patients, helping them access the right resources at the right time.
• Documenting clearly and accurately in the EHR and care-management systems during and after calls.
• Supporting quality outcomes (HEDIS, NCQA) by coordinating preventive services and managing chronic conditions.
• Participating in virtual meetings, ongoing education, and clinical training to stay current with care standards.
• Using multiple communication methods (phone, text, patient portals, email, AI-supported tools) to reach high-risk patients.
• Collaborating in AI-driven outreach programs that help connect with vulnerable populations.
• Protecting patient privacy in a secure, private home workspace.
• Performing additional responsibilities as needed to support patients and the care team.

Qualifications

• Active Compact Registered Nurse license in good standing is required.
• 3+ years of RN Case Management experience, preferably in outpatient or ambulatory care.
• 3+ years of RN Case Management experience, specifically focused on complex pediatric cases
• Strong critical-thinking and problem-solving skills to anticipate barriers and drive care forward.
• Ability to work independently, manage multiple priorities, and make sound clinical decisions remotely.
• Outstanding communication—warm, clear, confident, and patient-focused.
• Excellent telephonic interviewing skills and the ability to document accurately in real time.
• High comfort level with technology: EMRs, care-management systems, multi-screen workflow, Microsoft Office, and telecommunication tools.
• Understanding of accreditation and quality standards (NCQA, HEDIS).
• A quiet, private home office suitable for patient calls and handling PHI.
• Alignment with Guidehealth policies, clinical protocols, and compliance standards.

• BSN and Case Management certification preferred.