Remote RN Care Manager — Utilization & Care Coordination

Highmark Health

Idaho Falls (ID)

Remote

USD 68,000 - 106,000

Full time

6 days ago

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Job summary

Highmark Inc. is seeking a full-time remote Health Care Case Management professional. Responsibilities include reviewing care plans, ensuring regulatory compliance, and identifying opportunities for Health Coaching and case management interventions.

The role requires collaboration with providers, educating staff, and driving quality improvements to meet member needs. The ideal candidate has an RN license (PA or multi-state via eNLC), 3 years of related clinical experience, and a Bachelor’s in

Qualifications

Active RN license in PA or multi-state license via eNLC.
Bachelor’s degree in Nursing preferred.
Experience in UM/CM/QA/Managed Care is an asset.

Responsibilities

Implement care management review processes per established criteria and guidelines.
Ensure compliance with applicable state, federal laws and regulatory rules.
Carry out care management reviews using approved policies and medical policies.
Promote quality and efficiency in care management delivery.
Protect member privacy and handle information within legal boundaries.
Refer members to Health Coaching/case management when needed.
Educate providers and vendors to streamline processes and build relationships.
Develop positive working relationships with internal and external customers.
Use outcomes data to improve services and drive improvements.