Remote RN Care Manager for Case Management & Outcomes

Highmark Health; Maryland; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. seeks a full-time registered nurse for a remote role requiring weekend availability and three weekdays. You will lead utilization management and coordinate care through health coaching and case management interventions.

Responsibilities include applying criteria, ensuring regulatory compliance, educating providers and members, and improving care outcomes through collaborative interventions and data analysis.

Qualifications

• 3 years of related, progressive clinical experience.
• Current RN licensure in PA or multi-state via eNLC.
• Experience in UM/CM/QA/Managed Care.
• Experience with acute inpatient and post-acute care.

Responsibilities

• Implement care management reviews per guidelines.
• Ensure compliance with state and federal laws.
• Follow approved care criteria and medical policies.
• Promote quality and efficiency in care management.
• Educate providers and members and refer to Health Coaching.
• Develop positive relationships with stakeholders.
• Use outcomes data to improve services.

Skills

Care management

Regulatory compliance

Data analysis

Communication

Team player

Prioritization

Problem solving

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. seeks a full-time registered nurse for a remote role requiring weekend availability and three weekdays. You will lead utilization management and coordinate care through health coaching and case management interventions.

Responsibilities include applying criteria, ensuring regulatory compliance, educating providers and members, and improving care outcomes through collaborative interventions and data analysis.