Remote RN Care Manager: Health Outcomes & Coordination

Highmark Health; Charlotte (NC); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. in the United States is seeking a full-time remote RN Care Manager who will implement utilization management strategies, review care appropriateness, and coordinate referrals to Health Coaching and case management.

The role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on improving provider and member satisfaction, analyzing care outcomes, and educating providers and vendors to streamline processes.

Qualifications

• Minimum 3 years of related, progressive clinical experience in the area.
• Experience in a clinical setting.
• RN experience preferred (3 years).
• RN Case Management, Care Management experience.
• Experience in UM/CM/QA/Managed Care.
• Experience with acute inpatient and post-acute care.
• Experience with skilled nursing and inpatient rehab.

Responsibilities

• Implement care management review processes per industry and corporate standards.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to established criteria and guidelines.
• Promote quality and efficiency in the delivery of care management services.
• Respect the member’s privacy, sharing only information relevant to the member’s care and within the framework of applicable laws.
• Practice within the scope of ethical principles.
• Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
• Employ collaborative interventions focusing on member health outcomes and provider resources.
• Educate professional and facility providers and vendors to streamline processes and develop network rapport.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve ongoing care management services.
• Other duties as assigned or requested

Skills

Regulatory knowledge

Multi-tasking

Communication skills

Data analysis

Team player

Prioritization

Software proficiency

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. in the United States is seeking a full-time remote RN Care Manager who will implement utilization management strategies, review care appropriateness, and coordinate referrals to Health Coaching and case management.

The role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on improving provider and member satisfaction, analyzing care outcomes, and educating providers and vendors to streamline processes.