Remote RN Care Manager - Health Outcomes & UM

Highmark Health; Provo (UT); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Care Management professional with weekend availability to implement care management reviews and improve provider and member outcomes.

You will review services, apply criteria, educate providers, and coordinate with Health Coaches and case management, while adhering to privacy laws and regulatory guidelines in a fast-paced health-plan environment.

Qualifications

• RN licensure in PA or multi-state licensure via eNLC
• Minimum 3 years of related clinical 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 reviews consistent with industry and corporate standards.
• Function in accordance with applicable state and federal laws.
• Implement reviews according to established criteria and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy and comply with laws.
• Identify and refer members for Health Coaching/case management.

Skills

Regulatory compliance

Data analysis

Communication skills

Team player

Time management

Tech literacy

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Care Management professional with weekend availability to implement care management reviews and improve provider and member outcomes.

You will review services, apply criteria, educate providers, and coordinate with Health Coaches and case management, while adhering to privacy laws and regulatory guidelines in a fast-paced health-plan environment.