Remote RN Care Manager - Case Management Specialist

Highmark Health; Washington (District of Columbia); 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 (Saturday and Sunday) and three weekdays. The position focuses on utilization management, care coordination, and improving provider and member satisfaction through proactive interventions.

The role involves adherence to regulatory standards, data analysis, and collaboration across care teams. Strong nursing licensure and prior case management experience are preferred.

Qualifications

• Required None
• PreferredBachelor’s Degree in Nursing

Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws.
• Practice within the scope of ethical principles.
• Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
• Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes, familiar with care options and resources.
• Educate professional and facility providers and vendors to streamline and improve processes.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve ongoing care management services.
• Other duties as assigned or requested

Skills

Clinical experience

RN license

UM/CM/QA

Data analysis

Communication

Regulatory knowledge

Multitasking

Education

Bachelor’s Degree in Nursing

Tools

Office software

Job description

Highmark Inc. is seeking a full-time RN Case Manager for a remote role requiring weekend availability (Saturday and Sunday) and three weekdays. The position focuses on utilization management, care coordination, and improving provider and member satisfaction through proactive interventions.

The role involves adherence to regulatory standards, data analysis, and collaboration across care teams. Strong nursing licensure and prior case management experience are preferred.