Remote RN Care Manager: Utilization & Care Coordination

Highmark Health; Providence (RI); Remote; USD 68,000 - 106,000; Full time

Benefits offered by this job

Health insurance

Job summary

Highmark Inc. is seeking a full-time remote Care Manager who will implement utilization management strategies, review care appropriateness, and refer members to Health Coaching.

The role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on improving provider and member satisfaction. Required is 3 years of clinical experience and RN licensure (PA or multi-state via eNLC); a Bachelor’s in Nursing is preferred.

Qualifications

• 3 years of related clinical experience in care management.
• RN licensure in PA or multi-state licensure via eNLC.
• Experience in UM/CM/QA/Managed Care.
• Bachelor’s Degree in Nursing preferred.
• Clinical experience in inpatient or outpatient settings.

Responsibilities

• Implement care management review processes aligned with standards.
• Ensure compliance with state and federal laws.
• Carry out reviews per established criteria and policies.
• Promote quality and efficiency in care management.
• Protect member privacy in accordance with laws.
• Identify and refer members to Health Coaching/case management.
• Educate providers and vendors to improve processes.
• Develop positive relationships with internal and external customers.

Skills

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Team player

Time management

Computer skills

Problem solving

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Care Manager who will implement utilization management strategies, review care appropriateness, and refer members to Health Coaching.

The role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on improving provider and member satisfaction. Required is 3 years of clinical experience and RN licensure (PA or multi-state via eNLC); a Bachelor’s in Nursing is preferred.