Remote RN Care Manager | Utilization & Care Coordination

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

Job summary

Highmark Health is seeking an experienced RN care manager for a remote, full-time role requiring weekend availability. You will implement utilization management strategies, review care appropriateness, and coordinate with Health Coaches to optimize member outcomes.

The position emphasizes privacy, compliance, and collaboration with providers, facilities, and vendors to continuously improve care quality and efficiency.

Qualifications

• 3 years of related, progressive clinical experience in care management.
• Experience in a clinical setting.
• Current RN licensure in PA or multi-state via eNLC preferred.
• Certification in Utilization Management or related field preferred.

Responsibilities

• Implement care management reviews per criteria and guidelines.
• Ensure compliance with state and federal laws.
• Promote quality and efficiency in care management.
• Refer members to Health Coaching/case management as needed.
• Educate providers and vendors to improve processes.
• Develop relationships with internal and external customers.
• Use outcomes data to improve care management.
• Respond to customer inquiries and offer interventions.

Skills

Regulatory compliance

Data analysis

Communication skills

Multitasking

Team player

Analytical thinking

Education

Bachelor’s Degree in Nursing

Tools

EHR systems

Job description

Highmark Health is seeking an experienced RN care manager for a remote, full-time role requiring weekend availability. You will implement utilization management strategies, review care appropriateness, and coordinate with Health Coaches to optimize member outcomes.

The position emphasizes privacy, compliance, and collaboration with providers, facilities, and vendors to continuously improve care quality and efficiency.