Remote RN Care Manager - Utilization & Care Coordination

Highmark Health; Lexington (KY); Teletrabalho; USD 68 000 - 106 000; Tempo integral

Resumo da oferta

Highmark Inc. is seeking a full-time remote care manager to implement utilization management strategies, review service appropriateness, and identify opportunities for Health Coach referrals.

The role requires weekend availability (Saturday and Sunday) in addition to three weekdays and involves educating providers and members while maintaining privacy and compliance. Preferred is a Bachelor's Degree in Nursing with 3+ years of clinical experience and RN licensure.

Qualificações

• Experience in care management or case management preferred.
• Knowledge of UM/CM/QA/Managed Care.
• Strong analytical and communication skills.

Responsabilidades

• Implement care management reviews per established criteria.
• Ensure compliance with state and federal laws.
• Promote quality and efficiency in care management.
• Identify and refer members to health coaching or case management.
• Educate providers and vendors to streamline processes.
• Build positive relationships with internal and external customers.

Conhecimentos

Care management

Regulatory compliance

Data analysis

Communication skills

Team collaboration

Privacy & HIPAA awareness

Formação académica

Bachelor's Degree in Nursing

Descrição da oferta de emprego

Highmark Inc. is seeking a full-time remote care manager to implement utilization management strategies, review service appropriateness, and identify opportunities for Health Coach referrals.

The role requires weekend availability (Saturday and Sunday) in addition to three weekdays and involves educating providers and members while maintaining privacy and compliance. Preferred is a Bachelor's Degree in Nursing with 3+ years of clinical experience and RN licensure.