Remote RN Care Manager: Utilization & Care Coordination

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

Job summary

Highmark Health in the United States is seeking a full-time remote Utilization Management Nurse. This role requires weekend availability (Saturday and Sunday) in addition to three weekdays and focuses on reviewing appropriateness of services and applying criteria for resource use.

You will identify opportunities for Health Coaching and care management referrals to improve outcomes for members. The incumbent will monitor care delivery, educate providers and members, analyze data to enhance

Qualifications

• Knowledge of care management and utilization review processes.
• Ability to interpret state and federal regulations relevant to managed care.
• Strong communication with providers, members, and vendors.

Responsibilities

• Implement care management reviews per criteria and policies.
• Ensure compliance with laws and regulatory standards.
• Promote quality and efficiency in care management services.
• Identify members who could benefit from Health Coaching/case management.
• Educate providers and vendors to improve processes and outcomes.
• Develop and maintain relationships with internal and external stakeholders.

Skills

Regulatory knowledge

Multitasking

Communication

Data analysis

Team player

Time management

Computer skills

Education

Bachelor’s Degree in Nursing

RN licensure (PA or eNLC)

Job description

Highmark Health in the United States is seeking a full-time remote Utilization Management Nurse. This role requires weekend availability (Saturday and Sunday) in addition to three weekdays and focuses on reviewing appropriateness of services and applying criteria for resource use.

You will identify opportunities for Health Coaching and care management referrals to improve outcomes for members. The incumbent will monitor care delivery, educate providers and members, analyze data to enhance