Remote RN Care Manager—Health Outcomes & UM

Highmark Health; Phoenix (AZ); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time RN Care Manager for a REMOTE role requiring weekend availability (Saturday and Sunday) and three weekdays. The position focuses on utilization management, coordinating care, and improving provider and member satisfaction through data-driven strategies.

Responsibilities include implementing review processes, educating providers, and ensuring compliance with state and federal laws. Strong collaboration with teams and a commitment to privacy are essential.

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization
• Experience in a clinical setting
• RN Case Management, Care Management
• Experience in UM/CM/QA/Managed Care
• Experience with acute inpatient and post-acute
• Experience with skilled nursing, inpatient Rehab

Responsibilities

• Implement care management review processes that align with industry and corporate standards
• Operate within applicable state and federal laws and regulatory compliance
• Execute care management reviews according to established criteria and policies
• Promote quality and efficiency in care management services
• Protect patient privacy and share only information relevant to care
• Educate providers and vendors to improve processes and relationships
• Develop and sustain relationships with internal and external customers
• Use outcomes data to improve care management services
• Support additional duties as assigned

Skills

Care management

Regulatory compliance

Data analysis

Written & verbal communication

Team collaboration

Privacy & HIPAA

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time RN Care Manager for a REMOTE role requiring weekend availability (Saturday and Sunday) and three weekdays. The position focuses on utilization management, coordinating care, and improving provider and member satisfaction through data-driven strategies.

Responsibilities include implementing review processes, educating providers, and ensuring compliance with state and federal laws. Strong collaboration with teams and a commitment to privacy are essential.