Remote RN Care Manager – Utilization & Coordination

Highmark Health

Indianapolis (IN)

Remote

USD 68,000 - 106,000

Full time

5 days ago

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Job summary

Highmark Inc. is seeking a full-time remote Care Manager role requiring weekend availability (Saturday and Sunday) in addition to three weekdays. The position focuses on utilization management, review of care appropriateness, and referral to Health Coach/case management.

It monitors provider performance, educates providers and members, and analyzes data to improve outcomes. Ideal candidates have RN experience, a nursing license (PA or multi-state via eNLC), and 3+ years of related clinical

Qualifications

Requires 3 years of related clinical experience in health care management.
RN experience preferred (3 years).
Current PA RN license or multi-state license (eNLC) required.

Responsibilities

Implement care management review processes that are consistent with established industry and corporate standards.
Function in accordance with applicable state, federal laws and regulatory compliance.
Implement all care management reviews according to established criteria and medical policies.
Promote quality and efficiency in the delivery of care management services.
Respect the member’s privacy and share only information relevant to care within legal bounds.
Identify and refer members to Health Coaching/case management interventions.
Educate providers and vendors to streamline processes and develop network rapport.
Develop and sustain positive working relationships with internal and external customers.
Utilize outcomes data to improve ongoing care management services.