Remote RN Care Manager - Utilization & Care Coordination

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

Job summary

Highmark Health is seeking a full-time, remote Care Manager with weekend availability to support utilization management and care coordination across Saturday, Sunday and three weekdays. The role involves applying clinical criteria to ensure appropriate resource use, identifying referrals to Health Coaching and case management, and resolving quality issues.

Required RN licensure (PA or multi-state via eNLC) and ~3 years of clinical experience in care management or a related field.

Qualifications

• Must have RN licensure and current license to practice in the relevant state.
• 3 years of related, progressive clinical experience in care management or a similar setting.
• RN Case Management, Care Management experience and UM/QA/Managed Care familiarity are preferred.

Responsibilities

• Implement care management review processes aligned with industry standards and the care manager’s discipline.
• Ensure compliance with applicable laws and regulations.
• Promote quality and efficiency in care management services.
• Protect member privacy and share only information relevant to care within legal bounds.
• Identify and refer members to Health Coaching/case management interventions when appropriate.
• Educate providers and facilities to streamline processes and strengthen network relations.
• Use outcomes data to improve ongoing care management services.

Skills

Regulatory knowledge

Multi-tasking

Communication skills

Data analysis

Team player

Prioritization

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time, remote Care Manager with weekend availability to support utilization management and care coordination across Saturday, Sunday and three weekdays. The role involves applying clinical criteria to ensure appropriate resource use, identifying referrals to Health Coaching and case management, and resolving quality issues.

Required RN licensure (PA or multi-state via eNLC) and ~3 years of clinical experience in care management or a related field.