Remote RN Care Manager — Care Coordination Pro

Highmark Health; Williamstown (NJ); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time RN Case Manager for a remote role requiring weekend availability (Sat/Sun) and three weekdays. Responsibilities include reviewing care, applying criteria for resource utilization, and coordinating Health Coaching and case management interventions to improve outcomes.

The role emphasizes privacy, ethical practice, and collaboration with providers, vendors, and internal teams to optimize patient care and satisfaction.

Qualifications

• Current PA RN licensure or multi-state licensure via eNLC (or as required by location).
• At least 3 years of progressive clinical experience in care management.
• Experience in UM/CM/QA/Managed Care preferred.
• Experience in acute inpatient and post-acute settings preferred.

Responsibilities

• Implement care management reviews per established guidelines and policies.
• Comply with state, federal laws and regulatory requirements.
• Educate providers and members; promote quality and efficiency in care management.
• Refer members to Health Coaching/case management as appropriate.
• Collaborate with internal/external stakeholders and sustain relationships.
• Utilize outcomes data to improve care management services.

Skills

Regulatory compliance

Care management

Data analysis

Communication skills

Team collaboration

HIPAA/privacy

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a full-time RN Case Manager for a remote role requiring weekend availability (Sat/Sun) and three weekdays. Responsibilities include reviewing care, applying criteria for resource utilization, and coordinating Health Coaching and case management interventions to improve outcomes.

The role emphasizes privacy, ethical practice, and collaboration with providers, vendors, and internal teams to optimize patient care and satisfaction.