Remote RN Care Manager — UM/Case Management Leader

Highmark Health

Louisiana

Remote

USD 68,000 - 106,000

Full time

5 days ago

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Job summary

Highmark Health is seeking a full-time remote Care Management Specialist who can work weekends (Saturday and Sunday) and three weekdays. The role focuses on utilization management, reviewing care appropriateness, applying criteria, and identifying opportunities for referral to Health Coaching or care management.

You will monitor the delivery of health care services, educate providers and members, analyze data to improve provider performance and member satisfaction, and respond to inquiries with

Qualifications

3+ years of related clinical experience in care management.
Experience in a clinical setting.
Current PA RN license or multi-state licensure via eNLC.
Certification in Utilization Management preferred.

Responsibilities

Implement care management review processes according to established criteria and guidelines.
Ensure compliance with state and federal laws.
Promote quality and efficiency in care management.
Respect the member privacy within legal frameworks.
Refer members to Health Coaching/case management when appropriate.
Educate providers and vendors to streamline processes.
Develop positive relationships with internal and external customers.
Utilize outcomes data to improve services.
Perform other duties as assigned.

Skills

Regulatory knowledge

Data analysis

Communication skills

Multitasking

Team player

Education

Bachelor’s Degree in Nursing

Job description

You will monitor the delivery of health care services, educate providers and members, analyze data to improve provider performance and member satisfaction, and respond to inquiries with

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