Remote RN Care Manager: UM & Care Coordination

Highmark Health; Butlerville (IN); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Nurse Care Manager to implement utilization management strategies and support member care. The role requires weekend availability (Saturday and Sunday) plus three weekdays, focusing on review of care appropriateness, referral to Health Coach/case management, and ongoing performance improvement.

The ideal candidate has about 3 years of clinical experience, RN licensure (PA or multi-state via eNLC), and strong analytical and communication skills.

Qualifications

• 3 years of related, progressive clinical experience in care management.
• Experience in a clinical setting.
• Current RN licensure (PA) or multi-state license via eNLC.
• Preferred: Certification in Utilization Management or related field.

Responsibilities

• Implement care management reviews per established criteria and policies.
• Ensure compliance with state, federal laws and regulatory standards.
• Carry out care management reviews and guidelines to improve care quality.
• Promote quality and efficiency in care management services.
• Respect privacy and share only information relevant to care.
• Identify and refer members to Health Coaching/case management when appropriate.
• Collaborate with providers, vendors, and internal teams to improve processes.
• Develop positive relationships with internal and external customers.
• Utilize outcomes data to enhance care management services.
• Other duties as assigned.

Skills

Regulatory compliance

Data analysis

Written and verbal communication

Team player

Multi-tasking

Organizational skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a remote Nurse Care Manager to implement utilization management strategies and support member care. The role requires weekend availability (Saturday and Sunday) plus three weekdays, focusing on review of care appropriateness, referral to Health Coach/case management, and ongoing performance improvement.

The ideal candidate has about 3 years of clinical experience, RN licensure (PA or multi-state via eNLC), and strong analytical and communication skills.