Remote RN Care Manager: Utilization & Care Coordination

Highmark Health; Columbia (SC); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Care Manager requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

The role implements utilization management strategies, reviews appropriateness of health care services, applies criteria to ensure proper resource use, and identifies opportunities for referral to Health Coach/case management. The position monitors outcomes and educates providers and members to improve performance and satisfaction.

Qualifications

• Current PA RN license or multi-state licensure via eNLC.
• Bachelor’s degree in Nursing preferred.
• Minimum 3 years of related clinical experience.
• Experience in UM/CM/QA/Managed Care preferred.

Responsibilities

• Implement care management review processes per standards.
• Ensure compliance with applicable laws/regulations.
• Follow established criteria and guidelines and medical policies.
• Promote quality and efficiency in care management services.
• Protect member privacy within legal frameworks.
• Refer members to Health Coaching/case management when appropriate.
• Educate providers and vendors to streamline processes and build relationships.
• Develop and sustain positive relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Perform other duties as assigned.

Skills

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Team collaboration

Time management

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Care Manager requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

The role implements utilization management strategies, reviews appropriateness of health care services, applies criteria to ensure proper resource use, and identifies opportunities for referral to Health Coach/case management. The position monitors outcomes and educates providers and members to improve performance and satisfaction.