Remote RN Care Manager — Care Coordination & Outcomes

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

Job summary

Highmark Health is seeking a full-time, remote Care Manager with weekend availability to implement utilization management strategies, review care services, and identify opportunities for Health Coaching and case management. You will monitor provider performance and member satisfaction while educating providers and members on best practices.

Required RN licensure (PA) or multi-state licensure via eNLC and a Bachelor’s Degree in Nursing are preferred, with about 3 years of related clinical

Qualifications

• RN licensure required (PA) or multi-state licensure via eNLC
• Bachelor’s Degree in Nursing preferred
• Approximately 3 years of related clinical experience

Responsibilities

• Implement care management review processes per established standards and practice discipline
• Ensure compliance with state and federal laws and regulatory requirements
• Promote quality and efficiency in care management services
• Educate professionals and vendors to streamline processes and improve networks
• Identify and refer members to Health Coaching/case management interventions
• Utilize outcomes data to enhance care management services
• Build and sustain positive relationships with internal and external customers

Skills

Regulatory compliance

Multi-tasking

Written & verbal communication

Data analysis

Team player

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time, remote Care Manager with weekend availability to implement utilization management strategies, review care services, and identify opportunities for Health Coaching and case management. You will monitor provider performance and member satisfaction while educating providers and members on best practices.

Required RN licensure (PA) or multi-state licensure via eNLC and a Bachelor’s Degree in Nursing are preferred, with about 3 years of related clinical