Remote RN Care Manager - Utilization & Care Coordination

Highmark Health; Las Vegas (NV); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a qualified RN with strong care management experience for a full-time remote role requiring weekend availability. The position involves reviewing care plans, ensuring compliance, and referring members to Health Coaching and case management resources.

Responsibilities include implementing care management processes, educating providers, analyzing outcomes data, and maintaining privacy according to applicable laws.

Qualifications

• Working knowledge of pertinent regulatory and compliance guidelines and medical policies.
• Excellent written and verbal communication skills.
• Ability to analyze data, measure outcomes, and develop action plans.
• Be enthusiastic, innovative, and flexible.
• Be a team player who possesses strong analytical and organizational skills.
• Excellent computer and software knowledge and skills.

Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws.
• Practice within the scope of ethical principles.
• Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
• Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member.
• Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
• 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 knowledge

Written and verbal communication

Data analysis and action planning

Multitasking in fast-paced environment

Team player

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a qualified RN with strong care management experience for a full-time remote role requiring weekend availability. The position involves reviewing care plans, ensuring compliance, and referring members to Health Coaching and case management resources.

Responsibilities include implementing care management processes, educating providers, analyzing outcomes data, and maintaining privacy according to applicable laws.