Remote RN Care Manager - Utilization & Care Coordination

Highmark Health; Athens (GA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Utilization Management Nurse to implement care management review processes and ensure compliant, high-quality health services. This role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on educating providers and members and improving care outcomes.

The position emphasizes collaboration, data-driven improvements, and adherence to HIPAA and privacy standards.

Qualifications

• Current State of PA RN licensure or multi-state licensure via eNLC.
• Certification in Utilization Management or related field preferred.
• 3 years RN experience in care management, UM/QA, or related field.

Responsibilities

• Implement care management reviews per established criteria and policies.
• Ensure compliance with state and federal laws.
• Promote quality and efficiency in care management services.
• Identify and refer members to Health Coaching/case management when appropriate.
• Educate providers and vendors to streamline processes and strengthen relationships.
• Utilize outcomes data to improve services.

Skills

Regulatory knowledge

Data analysis

Communication skills

Multi-tasking

Team collaboration

Privacy/compliance

Analytical thinking

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a remote Utilization Management Nurse to implement care management review processes and ensure compliant, high-quality health services. This role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on educating providers and members and improving care outcomes.

The position emphasizes collaboration, data-driven improvements, and adherence to HIPAA and privacy standards.