Remote Care Manager RN | Utilization & Care Coordination

Highmark Health; Boise (ID); A distancia; USD 68.000 - 106.000; Jornada completa

Descripción de la vacante

Highmark Inc. is seeking a full-time Registered Nurse for a remote care management role requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

You will implement utilization management strategies, review care plans, educate providers and members, and analyze data to improve performance and satisfaction. The ideal candidate has 3 years of clinical experience, RN licensure (PA or multi-state via eNLC), and may hold certifications in Utilization Management or related

Formación

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• Current PA RN licensure or multi-state licensure via eNLC.

Responsabilidades

• Implement care management review processes consistent with standards and guidelines.
• Ensure compliance with state and federal laws.
• Perform care management reviews using established criteria and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy within legal requirements.
• Identify and refer members to Health Coaching/case management when appropriate.
• Collaborate to streamline processes and build provider network relations.
• Educate providers and facilities to improve processes and outcomes.
• Develop and sustain positive relationships with internal and external customers.
• Use outcomes data to enhance care management services.
• Perform other duties as assigned.

Conocimientos

Regulatory compliance

Multi-tasking

Communication skills

Data analysis

Team player

Prioritization

Computer skills

Educación

Bachelor’s Degree in Nursing

Descripción del empleo

Highmark Inc. is seeking a full-time Registered Nurse for a remote care management role requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

You will implement utilization management strategies, review care plans, educate providers and members, and analyze data to improve performance and satisfaction. The ideal candidate has 3 years of clinical experience, RN licensure (PA or multi-state via eNLC), and may hold certifications in Utilization Management or related