Remote RN Care Manager - Utilization & Care Coordination

Highmark Health; California City (CA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time RN Care Manager for a remote role in California City, CA, requiring weekend availability (Saturday/Sunday) and three weekdays.

The role focuses on utilization management, reviewing care appropriateness, applying criteria, and coordinating with Health Coach/case management to enhance outcomes. The ideal candidate holds PA RN licensure or multi-state eNLC, with 3+ years of clinical experience; UM/CM experience and strong communication and data skills are

Qualifications

• Current PA RN licensure or multi-state licensure via eNLC.
• Preferred: Certification in Utilization Management or related field.
• 3 years of related, progressive clinical experience.
• Experience in a clinical setting.
• RN experience and CM/UM background are desirable.

Responsibilities

• Implement care management review processes per standards and guidelines.
• Ensure compliance with state and federal laws.
• Apply established criteria and policies to reviews.
• Promote quality and efficiency in care management services.
• Protect member privacy within legal requirements.
• Operate within ethical principles.
• Refer members to Health Coaching/case management when appropriate.
• Collaborate with providers and vendors to improve processes.
• Educate team members and providers to streamline workflows.
• Develop and sustain positive relationships with internal/external customers.
• Use outcomes data to improve care management services.
• Perform other duties as assigned.

Skills

Regulatory knowledge

Multitasking

Communication

Data analysis

Adaptability

Team player

Prioritization

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a full-time RN Care Manager for a remote role in California City, CA, requiring weekend availability (Saturday/Sunday) and three weekdays.

The role focuses on utilization management, reviewing care appropriateness, applying criteria, and coordinating with Health Coach/case management to enhance outcomes. The ideal candidate holds PA RN licensure or multi-state eNLC, with 3+ years of clinical experience; UM/CM experience and strong communication and data skills are