Remote RN Care Manager — Health Outcomes & Coaching

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

Job summary

Highmark Inc. is seeking a full-time RN-based Care Management professional for a REMOTE role requiring weekend work (Sat/Sun) and three weekdays.

The role centers on reviewing care appropriateness, applying criteria, and coordinating with Health Coaching and case management to improve provider and member satisfaction. The position emphasizes compliance with laws, quality improvement, and stakeholder education, with strong data analysis and collaboration across teams.

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• Excellent written and verbal communication skills.
• Ability to analyze data, measure outcomes, and develop action plans.

Responsibilities

• Implement care management review processes aligned with industry and corporate standards.
• Ensure compliance with state and federal laws and regulatory requirements.
• Execute care management reviews per established criteria and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy and handle information within legal boundaries.
• Refer members who may benefit from Health Coaching/case management.
• Educate providers and vendors to streamline processes and build network rapport.
• Develop positive relationships with internal and external customers.
• Utilize outcomes data to improve care management services.
• Perform other duties as assigned.

Skills

Regulatory knowledge

multitasking

Communication skills

Data analysis

Team player

Organizational skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time RN-based Care Management professional for a REMOTE role requiring weekend work (Sat/Sun) and three weekdays.

The role centers on reviewing care appropriateness, applying criteria, and coordinating with Health Coaching and case management to improve provider and member satisfaction. The position emphasizes compliance with laws, quality improvement, and stakeholder education, with strong data analysis and collaboration across teams.