Remote RN Care Manager – Utilization & Care Coordination

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

Job summary

Highmark Health is seeking a full-time Remote Utilization Management/Case Management RN. The role reviews care appropriateness, applies criteria for resource use, refers to Health Coach/case management when needed, and analyzes data to improve provider and member satisfaction.

Weekend availability plus three weekdays are required. Essential duties include operating care management reviews, meeting regulatory standards, coaching providers, and maintaining privacy.

Qualifications

• Working knowledge of regulatory and compliance guidelines and medical policies.
• Ability to multi-task in a fast-paced environment.
• Excellent written and verbal communication skills.
• Ability to analyze data, measure outcomes, and develop action plans.
• Familiarity with HIPAA privacy rules and security policies.

Responsibilities

• Implement care management review processes aligned with industry standards and policies.
• Ensure compliance with state and federal laws and regulatory requirements.
• Execute care management reviews per established criteria and guidelines.
• Promote quality and efficiency in care management delivery.
• Protect member privacy and share only information relevant to care.

Skills

Regulatory compliance

Data analysis

Communication

Privacy & HIPAA

Care coordination

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time Remote Utilization Management/Case Management RN. The role reviews care appropriateness, applies criteria for resource use, refers to Health Coach/case management when needed, and analyzes data to improve provider and member satisfaction.

Weekend availability plus three weekdays are required. Essential duties include operating care management reviews, meeting regulatory standards, coaching providers, and maintaining privacy.