Remote RN Care Manager—Care Coordination & Outcomes

Highmark Health; Vermont; A distancia; USD 68.000 - 106.000; Jornada completa

Descripción de la vacante

Highmark Inc. is seeking a full-time REMOTE Care Management professional with weekend availability (Saturday and Sunday) and three weekdays.

The role involves implementing utilization management strategies, reviewing care appropriateness, identifying opportunities for Health Coaching, and resolving quality issues. You will monitor care delivery, educate providers and members, and analyze data to improve outcomes.

Formación

• Regulatory guidelines knowledge and compliance awareness.
• Ability to analyze data, measure outcomes, and develop action plans.
• Excellent written and verbal communication skills.

Responsabilidades

• Implement care management review processes per standards and policies.
• Comply with applicable state and federal laws and regulatory requirements.
• Execute care management reviews according to established criteria and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy and comply with privacy laws.
• Follow ethical principles in practice.
• Identify members who could benefit from Health Coaching or case management.
• Collaborate to maximize member health outcomes and navigate care options.
• Educate providers and vendors to streamline processes and build relationships.
• Develop and sustain positive relationships with internal and external customers.
• Utilize outcomes data to improve care management services.
• Perform other duties as assigned.

Conocimientos

Regulatory compliance

Data analysis

Written & verbal communication

Team player

Multitasking

Fast-paced environment

Educación

Bachelor's Degree in Nursing

Descripción del empleo

Highmark Inc. is seeking a full-time REMOTE Care Management professional with weekend availability (Saturday and Sunday) and three weekdays.

The role involves implementing utilization management strategies, reviewing care appropriateness, identifying opportunities for Health Coaching, and resolving quality issues. You will monitor care delivery, educate providers and members, and analyze data to improve outcomes.