Remote RN Care Manager – Health Care Coordination

Highmark Health; Florida; A distancia; USD 68.000 - 106.000; Jornada completa

Descripción de la vacante

Highmark Inc. seeks a full-time remote RN with case management and utilization management expertise to support healthcare quality and patient outcomes. Weekend availability (Sat/Sun) in addition to three weekdays is required.

The role involves reviewing care appropriateness, applying criteria, referring to Health Coaching, and addressing quality issues while educating providers and members and analyzing data to improve performance.

Formación

• 3 years of related, progressive clinical experience in the area of specialization.
• RN licensure in PA or eNLC; appropriate state licensure may be required.
• Bachelor's Degree in Nursing preferred or equivalent.
• Experience in utilization management, care management, or managed care.

Responsabilidades

• Implement care management review processes aligned with standards and policy.
• Ensure compliance with state and federal regulations.
• Perform care management reviews per criteria and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy and adhere to laws.
• Identify and refer members for Health Coaching/case management.
• Educate providers and vendors to improve processes and relationships.
• Develop relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Other duties as assigned.

Conocimientos

RN Case Management

Care Management

UM/CM/QA/Managed Care

Data analysis

Regulatory compliance

Communication skills

Team collaboration

Prioritization

Educación

Bachelor's Degree in Nursing

RN licensure in PA or eNLC

Descripción del empleo

Highmark Inc. seeks a full-time remote RN with case management and utilization management expertise to support healthcare quality and patient outcomes. Weekend availability (Sat/Sun) in addition to three weekdays is required.

The role involves reviewing care appropriateness, applying criteria, referring to Health Coaching, and addressing quality issues while educating providers and members and analyzing data to improve performance.