Remote RN Care Manager: Utilization & Care Coordination

Highmark Health; Maine; Teletrabalho; USD 68 000 - 106 000; Tempo integral

Resumo da oferta

Highmark Health offers a remote Care Manager position requiring weekend availability (Saturday and Sunday) in addition to three weekdays. The role focuses on review of care appropriateness, resource utilization, and referrals to Health Coaching or case management to improve provider and member satisfaction.

You will monitor care delivery, educate providers and members, analyze data, and develop strategies to enhance care quality while ensuring privacy and regulatory compliance.

Qualificações

• 3 years of clinical experience in care management or related field.
• RN licensure current (PA or multi-state via eNLC).
• Certification in Utilization Management or related field preferred.

Responsabilidades

• Implement care management review processes aligned with standards and policies.
• Ensure compliance with state, federal laws and regulatory requirements.
• Apply established criteria and medical policies to reviews.
• Promote quality and efficiency in care management services.
• Protect patient privacy and share information only as allowed by law.
• Identify and refer members to Health Coaching/case management when appropriate.
• Educate providers and facilities to streamline processes and build relationships.
• Develop positive relationships with internal and external customers.
• Utilize outcomes data to improve care management services.

Conhecimentos

Regulatory guidance

Multi-tasking

Communication

Data analysis

Team player

Prioritization

Computer skills

Formação académica

Bachelor's degree in Nursing

Descrição da oferta de emprego

Highmark Health offers a remote Care Manager position requiring weekend availability (Saturday and Sunday) in addition to three weekdays. The role focuses on review of care appropriateness, resource utilization, and referrals to Health Coaching or case management to improve provider and member satisfaction.

You will monitor care delivery, educate providers and members, analyze data, and develop strategies to enhance care quality while ensuring privacy and regulatory compliance.