Remote RN Care Manager - Utilization & Care Coordination

Highmark Health; Massachusetts; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a registered nurse for a full-time remote role focusing on utilization management and care coordination. The position requires weekend availability (Saturday and Sunday) along with three weekdays, implementing care management reviews and improving provider and member satisfaction.

The ideal candidate has ~3 years of clinical experience, RN licensure (PA or multi-state via eNLC), and preferred RN Case Management/UM/CM experience.

Qualifications

• Bachelor’s Degree in Nursing required.
• Current RN licensure in PA or multi-state via eNLC preferred.
• ~3 years of clinical experience in the area of specialization.
• RN Case Management, Care Management experience preferred.
• Experience in UM/CM/QA/Managed Care and inpatient/outpatient settings.

Responsibilities

• Implement care management review processes per established criteria and policies.
• Ensure compliance with state/federal laws and regulatory requirements.
• Promote quality and efficiency in care management delivery.
• Respect patient privacy and share only information necessary for care.
• Identify and refer members to Health Coaching/case management when appropriate.
• Educate providers and vendors to streamline processes and improve care.
• Develop positive relationships with internal/external customers.
• Utilize outcomes data to improve services and member/provider satisfaction.
• Respond to customer inquiries and offer interventions or alternatives.

Skills

Regulatory knowledge

Multitasking

Communication

Data analysis

Team player

Prioritization

Computer literacy

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a registered nurse for a full-time remote role focusing on utilization management and care coordination. The position requires weekend availability (Saturday and Sunday) along with three weekdays, implementing care management reviews and improving provider and member satisfaction.

The ideal candidate has ~3 years of clinical experience, RN licensure (PA or multi-state via eNLC), and preferred RN Case Management/UM/CM experience.