Remote RN Care Manager – Utilization & Care Coordination

Highmark Health; Hawaii; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health in the United States is seeking a remote Care Management RN to lead utilization review with weekend availability. You will apply evidence-based criteria, coordinate with Health Coaching, and drive improvements in provider and member outcomes.

The role requires RN licensure (PA or eNLC), 3+ years of clinical experience, and strong data/communication skills. Remote work option with weekend shifts supports flexible scheduling.

Qualifications

• 3 years of related clinical experience in care management.
• RN licensure in PA or multi-state eNLC as applicable.
• Experience in Utilization Management / Case Management.
• Strong knowledge of healthcare regulations and compliance.

Responsibilities

• Implement care management reviews per established criteria.
• Ensure compliance with state and federal laws.
• Apply guidelines and medical policies in reviews.
• Promote quality and efficiency in care management.
• Protect member privacy and information security.
• Refer members for Health Coaching or case management as needed.
• Educate providers and vendors to improve processes.
• Develop positive relationships with internal/external customers.
• Utilize outcomes data to improve services.

Skills

Care management

RN licensure

Data analysis

Communication skills

Team player

Multi-tasking

Regulatory compliance

Problem solving

Education

Bachelor's Degree in Nursing

Tools

EHR systems

Job description

Highmark Health in the United States is seeking a remote Care Management RN to lead utilization review with weekend availability. You will apply evidence-based criteria, coordinate with Health Coaching, and drive improvements in provider and member outcomes.

The role requires RN licensure (PA or eNLC), 3+ years of clinical experience, and strong data/communication skills. Remote work option with weekend shifts supports flexible scheduling.