Remote RN Care Manager: Utilization & Care Management

Highmark Health; Kailua (HI); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a RN Care Manager for a full-time remote role that requires weekend availability (Saturday and Sunday) in addition to three weekdays.

The position focuses on utilization management, reviewing care appropriateness, applying criteria, and guiding members to Health Coaching and case management resources. The role emphasizes protecting privacy, regulatory compliance, and collaboration with providers and internal teams to improve outcomes and patient satisfaction.

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• Current State of PA RN licensure or multi-state licensure (eNLC) may be required depending on where care is provided.
• Certification in Utilization Management or related field is preferred.

Responsibilities

• Implement care management review processes per standards and policies.
• Ensure compliance with state and federal laws and regulatory requirements.
• Apply established criteria for care management reviews and guidelines.
• Promote quality and efficiency in care management services.
• Protect member privacy and share only necessary information.
• Refer members to Health Coaching/case management when appropriate.
• Collaborate with providers and vendors to streamline processes.
• Develop relationships with internal and external customers.
• Utilize outcomes data to improve care management services.
• Perform other duties as assigned.

Skills

Regulatory compliance

Multitasking

Communication skills

Data analysis

Team player

Prioritize work

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a RN Care Manager for a full-time remote role that requires weekend availability (Saturday and Sunday) in addition to three weekdays.

The position focuses on utilization management, reviewing care appropriateness, applying criteria, and guiding members to Health Coaching and case management resources. The role emphasizes protecting privacy, regulatory compliance, and collaboration with providers and internal teams to improve outcomes and patient satisfaction.