Remote RN Care Manager: Utilization & Case Management

Highmark Health; Charleston (WV); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time remote RN Care Manager with weekend availability (Saturday and Sunday) and three weekdays, to review care, apply utilization criteria, and identify opportunities for Health Coaching and case management.

The role monitors care delivery, educates providers and members, analyzes data to improve outcomes, and ensures privacy and compliance while collaborating with internal teams.

Strong communication and analytical skills are essential.

Qualifications

• Requires RN licensure (PA preferred or eNLC acceptable) and 3+ years clinical experience in care management or UM/CM/QA.
• Bachelor’s Degree in Nursing preferred.
• Experience with acute inpatient and post-acute settings is a plus.

Responsibilities

• Implement care management review processes per criteria and guidelines.
• Ensure compliance with state and federal laws and policies.
• Refer members to Health Coaching or case management as appropriate.
• Educate providers and facilities to streamline processes and improve outcomes.
• Analyze outcomes data to drive service improvements and member satisfaction.

Skills

Care management

Data analysis

Communication

Regulatory compliance

Team collaboration

Privacy and ethics

Multitasking

Analytical thinking

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time remote RN Care Manager with weekend availability (Saturday and Sunday) and three weekdays, to review care, apply utilization criteria, and identify opportunities for Health Coaching and case management.

The role monitors care delivery, educates providers and members, analyzes data to improve outcomes, and ensures privacy and compliance while collaborating with internal teams.

Strong communication and analytical skills are essential.