Remote RN Care Manager – Care Coordination & Outcomes

Highmark Health; Baton Rouge (LA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a Remote Care Management professional to implement utilization review processes and coordinate health management strategies.

This role requires weekend availability (Saturday and Sunday) plus three weekdays, with responsibilities spanning provider education, data-driven care improvements, and collaboration across teams. The ideal candidate has 3+ years of clinical experience in care/case management, current RN licensure (PA or eNLC), and a preference for UB/UM QA

Qualifications

• RN with active PA license or equivalent eNLC license.
• 3+ years of clinical experience in care management or case management.
• Experience with utilization management, QA, or managed care preferred.

Responsibilities

• Implement care management review processes aligned with standards and guidelines.
• Operate within state/federal laws and regulatory requirements.
• Refer members for Health Coaching/case management when appropriate.
• Educate providers and members; analyze outcomes data to improve care management.
• Build relationships with internal/external stakeholders and sustain collaboration.

Skills

Care management

Regulatory compliance

Data analysis

Written & verbal communication

Multitasking

Team player

Prioritization

Computer skills

Education

Bachelor’s Degree in Nursing

RN licensure (PA)

Certification in Utilization Management (preferred)

Job description

Highmark Inc. is seeking a Remote Care Management professional to implement utilization review processes and coordinate health management strategies.

This role requires weekend availability (Saturday and Sunday) plus three weekdays, with responsibilities spanning provider education, data-driven care improvements, and collaboration across teams. The ideal candidate has 3+ years of clinical experience in care/case management, current RN licensure (PA or eNLC), and a preference for UB/UM QA