Remote RN Care Manager — Case Management & Health Coaching

Highmark Health; Clayton (NC); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Care Management professional to implement utilization review processes and improve member outcomes. The role requires weekend availability and three weekdays, with responsibilities spanning review and referral to health coaching while ensuring privacy and compliance.

The position emphasizes collaboration with providers and a data-driven approach to enhance care quality, with pay range $68,400.00–$105,900.00 and RN licensure requirements.

Qualifications

• RN licensure required; state-specific licensure may be required.
• Bachelor’s Degree in Nursing preferred.
• 3 years of related clinical experience.

Responsibilities

• Implement care management reviews per established criteria and guidelines.
• Ensure compliance with applicable state, federal laws and regulatory requirements.
• Carry out care management reviews according to approved policies and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect patient privacy and share information only as permitted by law.
• Practice within ethical principles while caring for members.
• Identify and refer members to Health Coaching/case management when appropriate.
• Collaborate with providers and vendors to streamline processes and build rapport.
• Develop and sustain positive relationships with internal and external customers.
• Use outcomes data to improve ongoing care management services.
• Perform additional duties as assigned.

Skills

Regulatory guidelines

Multi-tasking

Written and verbal communication

Data analysis

Enthusiastic, flexible

Team player

Prioritize deadlines

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a remote Care Management professional to implement utilization review processes and improve member outcomes. The role requires weekend availability and three weekdays, with responsibilities spanning review and referral to health coaching while ensuring privacy and compliance.

The position emphasizes collaboration with providers and a data-driven approach to enhance care quality, with pay range $68,400.00–$105,900.00 and RN licensure requirements.