Remote RN Care Manager - Utilization & Health Coach Liaison

Highmark Health; Santa Fe (NM); Teletrabalho; USD 68 000 - 106 000; Tempo integral

Resumo da oferta

Highmark Inc. is seeking a full-time remote RN for utilization management. The role requires weekend availability (Saturday and Sunday) and three weekdays, focusing on review of care services, applying criteria, referrals to health coaching, and quality issue resolution.

Responsible for educating providers and members, analyzing data, and supporting proactive care management. Requires 3 years of related clinical experience and RN licensure (PA or multi-state via eNLC); Bachelor’s in Nursing

Qualificações

• Regulatory guidelines and medical policies knowledge.
• Ability to multitask in a fast-paced environment.
• Strong written and verbal communication.
• Ability to analyze data, measure outcomes, and develop action plans.

Responsabilidades

• Implement care management review processes per standards and policies.
• Ensure compliance with state and federal laws.
• Apply criteria and guidelines for care reviews and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy within legal requirements.
• Refer members to Health Coaching/case management as needed.
• Educate providers and vendors to improve processes.
• Develop positive relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Other duties as assigned.

Conhecimentos

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Adaptability

Team player

Prioritization

Computer skills

Formação académica

Bachelor’s degree in Nursing

Descrição da oferta de emprego

Highmark Inc. is seeking a full-time remote RN for utilization management. The role requires weekend availability (Saturday and Sunday) and three weekdays, focusing on review of care services, applying criteria, referrals to health coaching, and quality issue resolution.

Responsible for educating providers and members, analyzing data, and supporting proactive care management. Requires 3 years of related clinical experience and RN licensure (PA or multi-state via eNLC); Bachelor’s in Nursing