Remote RN Care Manager — Utilization & Case Management

Highmark Health

Annapolis (MD)

Remote

USD 68,000 - 106,000

Full time

5 days ago

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Job summary

Highmark Health is seeking a RN Care Manager for a remote, full-time role requiring weekend availability (Saturday and Sunday) plus three weekdays. The position implements utilization management strategies, reviews service appropriateness, and guides members to Health Coaching or case management when needed.

The role involves monitoring care delivery, educating providers, protecting privacy, and using data to improve outcomes.

Qualifications

RN licensure with PA license or multi-state licensure via eNLC.
Bachelor’s degree in nursing preferred.
Minimum 3 years of related clinical experience in care management.
Experience in UM/CM/QA/Managed Care.

Responsibilities

Implement care management reviews per established criteria and guidelines.
Comply with state and federal laws and regulatory requirements.
Perform care management reviews according to medical policies.
Promote quality and efficiency in care management services.
Protect member privacy and share information as allowed by law.
Refer members to Health Coaching or case management when appropriate.
Educate providers and vendors to streamline processes and build network rapport.
Develop and sustain positive relationships with internal and external customers.
Use outcomes data to improve care management services.
Perform other duties as assigned.