Remote RN Care Manager: Utilization & Care Coordination

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

Job summary

Highmark Health is seeking a full-time remote Utilization Management nurse to implement care management reviews and coordinate care for members. The position requires weekend availability (Saturday and Sunday) plus three weekdays, with responsibilities spanning review of services, application of criteria, and referral to Health Coaching as needed.

You will educate providers and members, monitor outcomes, ensure privacy, and develop strategies to improve performance and satisfaction.

Qualifications

• Registered nurse with PA license or multi-state licensure via eNLC
• Approximately 3 years of progressive clinical experience
• RN Case Management / Care Management experience preferred

Responsibilities

• Implement care management reviews aligned with standards and policies
• Ensure compliance with state and federal laws and regulations
• Refer members to health coaching or case management as needed
• Use outcomes data to improve care management services
• Educate providers and vendors to streamline processes

Skills

Regulatory compliance

Communication skills

Data analysis

Team collaboration

Multitasking

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time remote Utilization Management nurse to implement care management reviews and coordinate care for members. The position requires weekend availability (Saturday and Sunday) plus three weekdays, with responsibilities spanning review of services, application of criteria, and referral to Health Coaching as needed.

You will educate providers and members, monitor outcomes, ensure privacy, and develop strategies to improve performance and satisfaction.