Remote RN Care Manager: Utilization & Health Coaching

Highmark Health; Austin (TX); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Care Management professional available on weekends and three weekdays. The role focuses on reviewing the appropriateness of health care services, applying utilization criteria, and identifying referrals to Health Coach/case management.

The job requires RN licensure and clinical experience, with a strong emphasis on regulatory compliance, data analysis, and educating providers and members to improve outcomes and satisfaction.

Qualifications

• Working knowledge of regulatory and compliance guidelines and medical policies.
• Ability to multi task in a fast-paced environment.
• Excellent written and verbal communication skills.
• Ability to analyze data, measure outcomes, and develop action plans.

Responsibilities

• Implement care management review processes per industry and corporate standards.
• Ensure compliance with state and federal laws and regulations.
• Apply criteria and policies for care management reviews.
• Promote quality and efficiency in care management services.
• Educate providers and members on care options and resources.
• Develop and sustain relationships with internal and external customers.
• Use outcomes data to improve care management services.

Skills

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Team player

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Care Management professional available on weekends and three weekdays. The role focuses on reviewing the appropriateness of health care services, applying utilization criteria, and identifying referrals to Health Coach/case management.

The job requires RN licensure and clinical experience, with a strong emphasis on regulatory compliance, data analysis, and educating providers and members to improve outcomes and satisfaction.