Remote Care Manager RN - Weekend Availability

Highmark Health; Iowa; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Care Manager RN to oversee utilization management, review care appropriateness, and coordinate with Health Coaches. This full-time role requires weekend availability (Saturday and Sunday) plus three weekdays, focusing on improving provider and member satisfaction.

Responsibilities include applying criteria, adhering to medical policies, educating providers, analyzing data, and developing action plans, while ensuring privacy and ethical practice in

Qualifications

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

Responsibilities

• 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 care management reviews according to established criteria and medical policies.
• Promote quality and efficiency in care management services.
• Respect member privacy and share information appropriately.
• Identify and refer members to Health Coaching/case management interventions.
• Educate providers and vendors to streamline processes and develop network relationships.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve care management services.

Skills

Regulatory compliance

Data analysis

Communication skills

Team player

Multitasking

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Health is seeking a remote Care Manager RN to oversee utilization management, review care appropriateness, and coordinate with Health Coaches. This full-time role requires weekend availability (Saturday and Sunday) plus three weekdays, focusing on improving provider and member satisfaction.

Responsibilities include applying criteria, adhering to medical policies, educating providers, analyzing data, and developing action plans, while ensuring privacy and ethical practice in