Remote RN Care Manager: Utilization & Care Coordination

Highmark Health; Boston (MA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote RN with 3+ years of clinical experience to drive utilization management and care coordination for members.

Weekend availability (Saturday and Sunday) plus three weekdays is required, with duties spanning review of healthcare services, adherence to policies, and proactive member education. The role emphasizes data analysis, collaboration with providers, and ensuring privacy under HIPAA, with opportunities to lead process improvements and coordinate with

Qualifications

• RN licensure in PA or multi-state via eNLC
• 3 years of related clinical experience in the area of specialization
• Bachelor’s Degree in Nursing preferred

Responsibilities

• Implement care management review processes in line with industry and corporate standards
• Function in accordance with state, federal laws and regulatory compliance
• Implement reviews according to criteria, guidelines and medical policies
• Promote quality and efficiency in care management services
• Educate providers and members on care options and resources
• Develop and sustain relationships with internal and external customers
• Utilize outcomes data to improve care management services

Skills

Communication skills

Data analysis

Multi-tasking

Computer skills

Team player

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote RN with 3+ years of clinical experience to drive utilization management and care coordination for members.

Weekend availability (Saturday and Sunday) plus three weekdays is required, with duties spanning review of healthcare services, adherence to policies, and proactive member education. The role emphasizes data analysis, collaboration with providers, and ensuring privacy under HIPAA, with opportunities to lead process improvements and coordinate with