Remote RN Care Manager: Utilization & Care Coordination

Highmark Health; Lincoln (NE); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time remote Care Manager to support utilization management. The role requires weekend availability (Saturday and Sunday) and three weekdays, focusing on reviewing services, applying criteria, and identifying opportunities for Health Coaching and case management.

You will monitor care delivery, educate providers and members, analyze data to improve outcomes, and respond to inquiries with interventions or alternatives.

Qualifications

• 3 years of related, progressive clinical experience in care management.
• RN licensure current in PA or multi-state licensure via eNLC.
• Experience in UM/CM/QA/Managed Care.
• Experience with acute inpatient and post-acute care.
• Experience with skilled nursing and inpatient rehab.

Responsibilities

• Implement care management review processes per industry standards.
• Ensure compliance with state and federal laws.
• Apply criteria and guidelines to care management reviews.
• Promote quality and efficiency in care management delivery.
• Protect privacy and share only information relevant to care.
• Refer members to Health Coaching/case management when beneficial.
• Educate providers and vendors to streamline processes.
• Develop and sustain positive working relationships with customers.
• Utilize outcomes data to improve care management services.
• Other duties as assigned.

Skills

Clinical care management

UM/CM/QA/Managed Care

RN licensure PA/eNLC

Data analysis

Communication skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Health is seeking a full-time remote Care Manager to support utilization management. The role requires weekend availability (Saturday and Sunday) and three weekdays, focusing on reviewing services, applying criteria, and identifying opportunities for Health Coaching and case management.

You will monitor care delivery, educate providers and members, analyze data to improve outcomes, and respond to inquiries with interventions or alternatives.