Remote RN Care Manager: Utilization & Care Coordination

Highmark Health; Carson City (NV); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Care Management professional available on weekends (Sat/Sun) and three weekdays.

The role focuses on utilization management, applying criteria to ensure appropriate care, and guiding members to Health Coaching and care management interventions. The position requires RN licensure with at least 3 years of clinical experience; a Bachelor’s Degree in Nursing is preferred.

Qualifications

• Current PA RN licensure or multi-state licensure (eNLC) as applicable.
• Bachelor’s Degree in Nursing preferred.
• 3 years of clinical experience required.

Responsibilities

• Implement care management reviews per criteria and guidelines.
• Ensure compliance with state and federal laws.
• Educate providers and members on care options.
• Refer members to Health Coaching or case management.
• Use outcomes data to improve care management services.
• Develop relationships with internal and external customers.

Skills

Regulatory compliance

Data analysis

Communication skills

Team player

Analytical skills

Time management

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Care Management professional available on weekends (Sat/Sun) and three weekdays.

The role focuses on utilization management, applying criteria to ensure appropriate care, and guiding members to Health Coaching and care management interventions. The position requires RN licensure with at least 3 years of clinical experience; a Bachelor’s Degree in Nursing is preferred.