Remote RN Care Manager — Care Coordination & UM

Highmark Health; Iowa Center (IA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Care Management professional available on weekends (Saturday and Sunday) and three weekdays. This role emphasizes utilization management, reviewing services, applying criteria for resource use, and referrals to Health Coaching or case management.

You will educate providers and members, analyze data to enhance provider and member satisfaction, and safeguard privacy in all interactions. RN licensure and clinical care management experience are required.

Qualifications

• RN licensure in good standing and active practice.
• 3 years of related clinical experience in care management.
• Experience with UM/CM/QA/Managed Care.

Responsibilities

• Implement care management review processes in line with standards.
• Ensure compliance with state and federal laws.
• Apply criteria to determine appropriate care and resource use.
• Identify opportunities for Health Coaching/case management referrals.
• Educate providers and vendors to improve processes.
• Develop relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Respond to member inquiries and offer interventions.

Skills

Regulatory compliance

Multi-tasking

Communication skills

Data analysis

Team player

Deadline prioritization

Computer literacy

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Care Management professional available on weekends (Saturday and Sunday) and three weekdays. This role emphasizes utilization management, reviewing services, applying criteria for resource use, and referrals to Health Coaching or case management.

You will educate providers and members, analyze data to enhance provider and member satisfaction, and safeguard privacy in all interactions. RN licensure and clinical care management experience are required.