Remote RN Care Manager — Utilization & Care Coordination

Highmark Health; Hydaburg (AK); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time, remote RN with care management expertise to implement utilization management strategies and coordinate member care. The role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on improving provider and member satisfaction through data-driven interventions.

Responsibilities include applying established care management criteria, promoting quality, and educating providers and vendors.

Qualifications

• 3 years of related, progressive clinical experience in care management or utilization management.
• RN licensure and current practice in applicable state(s).
• Bachelor’s Degree in Nursing preferred.

Responsibilities

• Implement care management reviews consistent with established industry and corporate standards.
• Function in accordance with applicable state and federal laws and regulatory compliance.
• Implement care management reviews per established criteria and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect member privacy and share only information relevant to care within legal restrictions.
• Identify and refer members who could benefit from Health Coaching or case management interventions.
• Educate providers and vendors to streamline processes and build network rapport.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve ongoing care management services.
• Other duties as assigned or requested.

Skills

Regulatory compliance

Communication skills

Data analysis

Multi-tasking

Computer literacy

Education

Bachelor’s Degree in Nursing

Tools

HIPAA compliance tools

Job description

Highmark Health is seeking a full-time, remote RN with care management expertise to implement utilization management strategies and coordinate member care. The role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on improving provider and member satisfaction through data-driven interventions.

Responsibilities include applying established care management criteria, promoting quality, and educating providers and vendors.