Remote RN Care Manager - Utilization & Care Coordination

Highmark Health; Dover; Remote; GBP 51.000 - 80.000; Vollzeit

Zusammenfassung

Highmark Inc. is seeking a full-time remote Care Manager with weekend availability to oversee utilization management, assess care needs, and coordinate with Health Coaches. The role includes evaluating provider performance and improving member satisfaction while adhering to privacy and regulatory requirements.

The ideal candidate will have an RN license, 3 years of clinical experience, and familiarity with UM/CM/QA/Managed Care, with a preference for RN Case Management experience.

Qualifikationen

• Working knowledge of pertinent regulatory and compliance guidelines and medical policies.
• Ability to multi task and perform in a fast paced and often intense environment.
• Excellent written and verbal communication skills.
• Ability to analyze data, measure outcomes, and develop action plans.
• Be enthusiastic, innovative, and flexible.
• Be a team player who possesses strong analytical and organizational skills.
• Demonstrated ability to prioritize work demands and meet deadlines.
• Excellent computer and software knowledge and skills.

Aufgaben

• Implement care management review processes that are consistent with established industry and corporate standards.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to established criteria and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy and share only relevant information.

Kenntnisse

Regulatory knowledge

Multitasking

Communication

Data analysis

Adaptable / Flexible

Team player

Prioritization

Software proficiency

Ausbildung

Bachelor’s Degree in Nursing

Jobbeschreibung

Highmark Inc. is seeking a full-time remote Care Manager with weekend availability to oversee utilization management, assess care needs, and coordinate with Health Coaches. The role includes evaluating provider performance and improving member satisfaction while adhering to privacy and regulatory requirements.

The ideal candidate will have an RN license, 3 years of clinical experience, and familiarity with UM/CM/QA/Managed Care, with a preference for RN Case Management experience.