Remote RN Care Manager - Utilization & Care Coordination

Highmark Health; Saint Paul (MN); Teletrabalho; USD 68 000 - 106 000; Tempo integral

Resumo da oferta

Highmark Health in the United States is seeking a full-time RN responsible for utilization management and care coordination. This remote role requires weekend availability (Saturday and Sunday) in addition to three weekdays.

The position involves reviewing services for appropriateness, applying criteria for resource use, and identifying opportunities for referral to Health Coach/case management. Responsibilities include implementing care management reviews, ensuring compliance, promoting

Qualificações

• Required None
• Preferred Bachelor’s Degree in Nursing

Responsabilidades

• Implement care management reviews per policy and standards.
• Ensure compliance with state and federal laws.
• Apply established criteria and guidelines in reviews.
• Promote quality and efficiency in care management.
• Protect member privacy under privacy laws.
• Refer members to Health Coaching or case management.
• Educate providers and vendors to improve processes.
• Develop relationships with internal and external customers.

Conhecimentos

Regulatory guidelines

Multi-tasking

Written communication

Data analysis

Team player

Prioritization

Analytical skills

Computer skills

Formação académica

Bachelor’s Degree in Nursing

Descrição da oferta de emprego

Highmark Health in the United States is seeking a full-time RN responsible for utilization management and care coordination. This remote role requires weekend availability (Saturday and Sunday) in addition to three weekdays.

The position involves reviewing services for appropriateness, applying criteria for resource use, and identifying opportunities for referral to Health Coach/case management. Responsibilities include implementing care management reviews, ensuring compliance, promoting