Remote RN Care Manager (UM/CM) - Weekend Availability

Highmark Health; North Carolina; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Care Manager with nursing credentials to support utilization management. The role requires weekend availability and three weekdays, focusing on review of care appropriateness and resource utilization to improve provider and member outcomes.

Responsibilities include implementing reviews, ensuring privacy, and educating providers while collaborating across teams to enhance quality and efficiency in care delivery.

Qualifications

• 3 years of related, progressive clinical experience in the area of care management.
• Experience in a clinical setting.
• Current PA RN licensure or multi-state licensure via the Enhanced Nurse Licensure Compact (eNLC); other states may be required.
• Certification in Utilization Management or related field is preferred.
• Experience with acute inpatient and post-acute care.

Responsibilities

• Implement care management review processes aligned with standards and critera.
• Ensure compliance with applicable laws and regulatory requirements.
• Carry out care management reviews according to established guidelines and policies.
• Promote quality and efficiency in care management services.
• Respect patient privacy and share only information relevant to care.
• Practice within ethical principles.
• Identify and refer members who may benefit from Health Coaching or case management.
• Collaborate to maximize member health outcomes and streamline processes.
• Educate providers and vendors to improve workflows and relationships.
• Develop and maintain positive working relationships with customers.
• Use outcomes data to improve care management services.
• Perform other duties as assigned.

Skills

Care management

Regulatory compliance

Data analysis

Communication skills

Team collaboration

Quality improvement

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a remote Care Manager with nursing credentials to support utilization management. The role requires weekend availability and three weekdays, focusing on review of care appropriateness and resource utilization to improve provider and member outcomes.

Responsibilities include implementing reviews, ensuring privacy, and educating providers while collaborating across teams to enhance quality and efficiency in care delivery.