Remote RN Care Manager: Care Coordination

Highmark Health; New York (NY); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time REMOTE RN Case Manager to join our utilization management team. The role requires weekend availability (Sat/Sun) plus three weekdays, focusing on review of services, criteria application, and coordination with Health Coaching and case management to improve outcomes.

The ideal candidate has at least 3 years of clinical experience, RN licensure (PA or eNLC), and UM/CM experience. Strong data analysis and communication skills are essential.

Qualifications

• 3 years of related clinical experience
• RN licensure PA or eNLC multi-state
• Bachelor’s degree in Nursing preferred
• Utilization Management or Care Management experience preferred
• Experience with UM/CM/QA/Managed Care
• Inpatient and post-acute experience

Responsibilities

• Implement care management review processes per standards
• Ensure compliance with state and federal laws
• Apply criteria to approved guidelines and medical policies
• Promote quality and efficiency in care management
• Protect member privacy and data within legal requirements
• Refer members to Health Coaching/case management as appropriate
• Collaborate with providers and vendors to streamline processes
• Develop positive relationships with internal and external customers
• Use outcomes data to improve services
• Perform other duties as assigned

Skills

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Team player

Prioritization

Education

Bachelor's degree in Nursing

Job description

Highmark Inc. is seeking a full-time REMOTE RN Case Manager to join our utilization management team. The role requires weekend availability (Sat/Sun) plus three weekdays, focusing on review of services, criteria application, and coordination with Health Coaching and case management to improve outcomes.

The ideal candidate has at least 3 years of clinical experience, RN licensure (PA or eNLC), and UM/CM experience. Strong data analysis and communication skills are essential.