Remote RN Care Manager for Utilization & Outcomes

Highmark Health; Pennsylvania; Híbrido; USD 68 000 - 106 000; Tempo integral

Resumo da oferta

Highmark Inc. in the United States is seeking a full-time RN care manager for a remote position requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

The role focuses on utilization management, reviewing care appropriateness, applying criteria, and guiding referrals to Health Coaching and case management. Responsibilities include implementing care management reviews, ensuring regulatory compliance, educating providers, and using data to drive quality improvements

Qualificações

• Active PA RN license (or multi-state via eNLC)
• Bachelor's degree in Nursing preferred
• 3 years of clinical experience in care management/UM/CM

Responsabilidades

• Implement care management reviews per standards.
• Ensure compliance with state and federal laws.
• Implement reviews per established criteria and policies.
• Promote quality and efficiency in care management.
• Protect member privacy and adhere to laws.
• Refer members to Health Coaching/case management.
• Educate providers and staff to streamline processes.
• Develop relationships with internal and external customers.
• Use outcomes data to improve services.
• Other duties as assigned.

Conhecimentos

Regulatory knowledge

Data analysis

Communication skills

Team player

Multi-tasking

Problem solving

Formação académica

Bachelor's Degree in Nursing

Descrição da oferta de emprego

Highmark Inc. in the United States is seeking a full-time RN care manager for a remote position requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

The role focuses on utilization management, reviewing care appropriateness, applying criteria, and guiding referrals to Health Coaching and case management. Responsibilities include implementing care management reviews, ensuring regulatory compliance, educating providers, and using data to drive quality improvements