Remote RN Care Manager | Utilization & Care Coordination

Highmark Health; Kansas City (MO); A distancia; USD 68.000 - 106.000; Jornada completa

Descripción de la vacante

Highmark Health is seeking a full-time remote RN Care Manager to implement utilization management strategies and oversee care management reviews. The role includes collaborating with providers, coaching members, and improving provider and member satisfaction.

Weekend availability is required, with additional weekday shifts. Responsibilities encompass applying established criteria, ensuring policy compliance, educating staff, and using data to drive quality improvements.

Formación

• Active RN licensure in PA or multi-state licensure via eNLC
• 3 years of related clinical experience in care management
• Experience in UM/CM/QA/Managed Care

Responsabilidades

• Implement care management review processes per industry and corporate standards
• Ensure compliance with applicable state and federal laws
• Apply criteria and policies to care management reviews
• Promote quality and efficiency in care management services
• Respect patient privacy and ensure information is shared appropriately
• Refer members to Health Coaching/case management when beneficial
• Educate providers and vendors to streamline processes and build network rapport
• Develop positive relationships with internal and external customers
• Use outcomes data to improve care management services
• Perform other duties as assigned

Conocimientos

Care management

RN

Utilization management

Data analysis

Communication

Regulatory compliance

Team collaboration

Educación

Bachelor’s Degree in Nursing

Descripción del empleo

Highmark Health is seeking a full-time remote RN Care Manager to implement utilization management strategies and oversee care management reviews. The role includes collaborating with providers, coaching members, and improving provider and member satisfaction.

Weekend availability is required, with additional weekday shifts. Responsibilities encompass applying established criteria, ensuring policy compliance, educating staff, and using data to drive quality improvements.