Remote RN Care Manager — Utilization & Care Coordination

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

Job summary

Highmark Inc. is seeking a full-time care management professional for a REMOTE role that requires weekend availability (Saturday and Sunday) in addition to three weekdays.

The position implements utilization management strategies, reviews the appropriateness of health care services, identifies opportunities for referral to Health Coaching or case management, and educates providers and members to improve outcomes and satisfaction.

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization
• Experience in a clinical setting

Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline.
• 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. Is familiar with the various care options and provider resources available to the member.
• 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

Enthusiastic

Team player

Prioritize work

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a full-time care management professional for a REMOTE role that requires weekend availability (Saturday and Sunday) in addition to three weekdays.

The position implements utilization management strategies, reviews the appropriateness of health care services, identifies opportunities for referral to Health Coaching or case management, and educates providers and members to improve outcomes and satisfaction.