Remote RN Care Manager: Utilization & Care Coordination

Highmark Health; Tallahassee (FL); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Health Care Manager to implement effective utilization management strategies, review care appropriateness, and identify opportunities for Health Coach/case management referrals.

This role requires weekend availability (Saturday and Sunday) in addition to three weekdays and focuses on reducing variability while upholding privacy and compliance. You will educate providers and vendors, analyze data to improve provider performance and member satisfaction,

Qualifications

• Knowledge of applicable regulatory and compliance guidelines and medical policies.
• Ability to multi task in fast-paced environments.
• Strong written and verbal communication skills.
• Ability to analyze data and develop action plans.

Responsibilities

• Implement care management review processes per standards.
• Ensure compliance with state and federal laws.
• Apply criteria for care reviews and guidelines.
• Promote quality and efficiency in care management.
• Protect privacy and share information within legal bounds.
• Identify and refer members to Health Coaching/case management interventions.
• Educate providers and vendors to streamline processes.
• Develop and sustain relationships with customers.
• Use outcomes data to improve services.
• Perform other duties as assigned.

Skills

Regulatory knowledge

Multi-tasking

Communication skills

Data analysis

Team player

Prioritization

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Health Care Manager to implement effective utilization management strategies, review care appropriateness, and identify opportunities for Health Coach/case management referrals.

This role requires weekend availability (Saturday and Sunday) in addition to three weekdays and focuses on reducing variability while upholding privacy and compliance. You will educate providers and vendors, analyze data to improve provider performance and member satisfaction,