Remote RN Care Manager: Utilization & Case Management

Highmark Health; Oklahoma; Remoto; USD 68.000 - 106.000; Tempo pieno

Descrizione del lavoro

Highmark Health is seeking a Remote Nurse Care Manager to implement utilization management strategies across care settings. The role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on reviewing care appropriateness, applying criteria, and coordinating referrals to Health Coaching and case management.

The position emphasizes engaging with providers and members, analyzing data, and driving quality improvements while maintaining privacy and compliance with

Competenze

• Bachelor’s Degree in Nursing is preferred.
• ~3 years of related clinical experience in the area of specialization.
• RN licensure in PA or multi-state via eNLC required.
• Certification in Utilization Management preferred.

Mansioni

• Implement care management reviews per established criteria and policies.
• Ensure compliance with applicable laws and regulatory requirements.
• Identify and refer members for Health Coaching/case management when appropriate.
• Educate providers and members; improve care management processes.
• Utilize outcomes data to improve care management services.
• Perform other duties as assigned or requested.

Conoscenze

Regulatory knowledge

multitask handling

Written & verbal communication

Data analysis & outcomes

Team player

Formazione

Bachelor’s Degree in Nursing

Descrizione del lavoro

Highmark Health is seeking a Remote Nurse Care Manager to implement utilization management strategies across care settings. The role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on reviewing care appropriateness, applying criteria, and coordinating referrals to Health Coaching and case management.

The position emphasizes engaging with providers and members, analyzing data, and driving quality improvements while maintaining privacy and compliance with