Remote RN Care Manager — Utilization & Care Coordination

Highmark Health; Montana City (MT); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health seeks an experienced RN for a full-time remote care management role requiring weekend availability (Sat/Sun) and three weekdays. You will review care services, apply criteria for appropriate utilization, and coordinate with Health Coaches and care teams to improve member outcomes.

Responsibilities include implementing care-management reviews, ensuring regulatory compliance, educating providers, and using outcomes data to enhance service quality.

Qualifications

• Knowledge of regulatory guidelines and policies.
• Ability to multitask in a fast-paced environment.
• Strong written and verbal communication skills.
• Adept at data review, measurement, and action planning.
• Demonstrates enthusiasm, adaptability and teamwork.

Responsibilities

• Implement care management reviews per industry standards.
• Ensure compliance with state and federal laws.
• Apply established criteria and approved guidelines for reviews.
• Promote quality and efficiency in care management.
• Respect member privacy within legal requirements.
• Identify and refer members for Health Coaching/case management.
• Educate providers and vendors to streamline processes.
• Develop positive relationships with internal and external customers.
• Use outcomes data to improve services.
• Other duties as assigned.

Skills

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Innovative mindset

Team player

Time management

Software proficiency

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health seeks an experienced RN for a full-time remote care management role requiring weekend availability (Sat/Sun) and three weekdays. You will review care services, apply criteria for appropriate utilization, and coordinate with Health Coaches and care teams to improve member outcomes.

Responsibilities include implementing care-management reviews, ensuring regulatory compliance, educating providers, and using outcomes data to enhance service quality.