Remote RN Care Manager – Utilization & Care Coordination

Highmark Health; Lansing (MI); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Care Management professional with weekend availability (Saturday and Sunday) and three weekdays. The role implements utilization review, ensures appropriate services, and refers members to Health Coaching and case management as needed.

Preferred candidates hold a Bachelor’s Degree in Nursing with at least 3 years of clinical experience in UM/CM. Strong emphasis on privacy, compliance, and collaboration with providers to improve outcomes.

Qualifications

• Requires active RN licensure (PA or multi-state via eNLC) and clinical nursing experience.
• Bachelor’s degree in Nursing preferred.
• 3+ years of related clinical experience in care management or similar.
• Experience with utilization management and quality improvement is a plus.

Responsibilities

• Implement care management review processes per established standards.
• Ensure compliance with state and federal regulations.
• Refer members to Health Coaching/case management when appropriate.
• Educate providers and members to improve care quality and outcomes.
• Maintain confidentiality and privacy in all communications.

Skills

Regulatory compliance

Multi-tasking

Communication skills

Data analysis

Team player

Prioritization

Computer skills

Healthcare knowledge

Attention to detail

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Care Management professional with weekend availability (Saturday and Sunday) and three weekdays. The role implements utilization review, ensures appropriate services, and refers members to Health Coaching and case management as needed.

Preferred candidates hold a Bachelor’s Degree in Nursing with at least 3 years of clinical experience in UM/CM. Strong emphasis on privacy, compliance, and collaboration with providers to improve outcomes.