Remote RN Care Manager: Utilization & Care Coordination

Highmark Health; Fulton (MS); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Care Management professional to lead and implement utilization management strategies with weekend and weekday coverage. The role focuses on reviewing care appropriateness, applying criteria for resource use, and identifying opportunities for referral to Health Coaching and case management.

The position emphasizes educating providers and members, analyzing data to improve provider and member satisfaction, and addressing quality issues.

Qualifications

• Approximately 3 years of related clinical experience in care management.
• RN licensure or equivalent preferred (or active RN).

Responsibilities

• Implement care management reviews using established criteria and policies.
• Promote quality and efficiency in care management delivery.
• Educate providers and members; collaborate with network resources.
• Identify and refer members to Health Coaching/case management interventions.
• Use outcomes data to improve care management services.
• Protect member privacy and comply with applicable laws.

Skills

Communication skills

Data analysis

Multitasking

Team player

Analytical skills

Organizational skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a remote Care Management professional to lead and implement utilization management strategies with weekend and weekday coverage. The role focuses on reviewing care appropriateness, applying criteria for resource use, and identifying opportunities for referral to Health Coaching and case management.

The position emphasizes educating providers and members, analyzing data to improve provider and member satisfaction, and addressing quality issues.