Remote RN Care Manager: Case & Utilization Expert

Highmark; United States; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a remote RN Case Manager to support utilization management and care coordination.

The role requires weekend availability (Saturday and Sunday) in addition to three weekdays, with duties spanning review of services, adherence to policies, and proactive member engagement. The position emphasizes coordinating with providers, educating stakeholders, and using outcomes data to drive improvements in care quality and satisfaction.

Qualifications

• 3 years of progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• RN licensure in good standing or eligible.

Responsibilities

• Implement care management review processes per established standards.
• Comply with applicable state, federal laws and regulatory requirements.
• Execute care management reviews using approved criteria and guidelines.
• Promote quality and efficiency in care management services.
• Protect member privacy and share only necessary information.
• Educate providers and vendors to streamline processes.
• Develop relationships with internal and external customers.
• Utilize outcomes data to improve services.

Skills

Regulatory compliance

Multitasking

Verbal communication

Data analysis

Team player

Organizational skills

Deadline management

Computer skills

Education

Bachelor’s in Nursing

RN licensure

Tools

EHR software

Privacy & security tools

Job description

Highmark Inc. is seeking a remote RN Case Manager to support utilization management and care coordination.

The role requires weekend availability (Saturday and Sunday) in addition to three weekdays, with duties spanning review of services, adherence to policies, and proactive member engagement. The position emphasizes coordinating with providers, educating stakeholders, and using outcomes data to drive improvements in care quality and satisfaction.