Remote RN Care Manager – Utilization & Care Coordination

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

Job summary

Highmark Health seeks an experienced Registered Nurse Care Manager for a full-time remote position requiring weekend availability (Saturday and Sunday) and three weekdays. You will review appropriateness of services, apply utilization criteria, and identify opportunities for referral to Health Coaching and case management.

Dedicated to improving provider and member satisfaction, you will monitor care delivery, educate providers and members, and analyze data to drive quality improvements, while

Qualifications

• RN licensure required in PA or multi-state licensure via eNLC; location-based licensure may apply.
• Experience in UM/CM/QA/Managed Care preferred; knowledge of care management processes.

Responsibilities

• Implement care management reviews aligned with industry standards and care manager scope.
• Support regulatory compliance and proper policy adherence in daily work.
• Execute care reviews using established criteria and medical policies.
• Promote quality and efficiency in care management service delivery.
• Protect member privacy and share only information relevant to care.
• Identify and refer members to Health Coaching/case management when appropriate.
• Collaborate with providers and vendors to optimize processes and relationships.
• Develop and sustain positive relationships with internal/external customers.
• Utilize outcomes data to improve care management services.
• Perform other duties as assigned.

Skills

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Outcomes measurement

Action planning

Team collaboration

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health seeks an experienced Registered Nurse Care Manager for a full-time remote position requiring weekend availability (Saturday and Sunday) and three weekdays. You will review appropriateness of services, apply utilization criteria, and identify opportunities for referral to Health Coaching and case management.

Dedicated to improving provider and member satisfaction, you will monitor care delivery, educate providers and members, and analyze data to drive quality improvements, while