Remote RN Care Manager - Utilization & Care Coordination

Highmark Health; Honolulu (HI); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time RN with remote work availability to implement utilization management strategies, review care services, and coordinate with Health Coaches and case management.

The role requires weekend coverage (Saturday and Sunday) plus three weekdays, and involves analyzing data and improving provider performance and member satisfaction. The position emphasizes privacy, regulatory compliance, and collaboration with providers, vendors, and internal teams to optimize care

Qualifications

• 3 years of clinical experience in care management or related field.
• RN licensure in PA or multi-state via eNLC.
• Certification in Utilization Management preferred.

Responsibilities

• Implement care management review processes per standards and policies.
• Ensure compliance with state and federal laws.
• Perform care management reviews according to criteria and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy per laws and regulations.
• Refer members to Health Coaching/case management when appropriate.
• Educate providers and vendors to streamline processes.
• Develop positive relationships with internal and external customers.
• Utilize outcomes data to improve care management services.
• Other duties as assigned.

Skills

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Team player

Time management

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time RN with remote work availability to implement utilization management strategies, review care services, and coordinate with Health Coaches and case management.

The role requires weekend coverage (Saturday and Sunday) plus three weekdays, and involves analyzing data and improving provider performance and member satisfaction. The position emphasizes privacy, regulatory compliance, and collaboration with providers, vendors, and internal teams to optimize care