Remote RN Care Manager — Utilization & Care Coordination

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

Job summary

Highmark Health is seeking a remote Care Manager RN to support utilization management and care coordination. The role requires weekend availability (Saturday and Sunday) plus three weekdays, focusing on reviewing services, applying criteria, and improving member outcomes.

The position emphasizes privacy, ethical practice, and collaboration with providers to optimize care. A PA RN license (or multi-state via eNLC) is preferred, with substantial clinical experience in managed care settings.

Qualifications

• 3 years of related, progressive clinical experience in care management.
• Experience in utilization management or care management is preferred.

Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws.
• Practice within the scope of ethical principles.
• Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
• Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes.
• Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve ongoing care management services.
• Other duties as assigned or requested

Skills

Regulatory knowledge

Multi-tasking

Communication skills

Data analysis

Adaptability

Team player

Prioritization

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Health is seeking a remote Care Manager RN to support utilization management and care coordination. The role requires weekend availability (Saturday and Sunday) plus three weekdays, focusing on reviewing services, applying criteria, and improving member outcomes.

The position emphasizes privacy, ethical practice, and collaboration with providers to optimize care. A PA RN license (or multi-state via eNLC) is preferred, with substantial clinical experience in managed care settings.