Remote RN Care Manager | Utilization & Health Coaching

Highmark Health; Central City (CO); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time remote Care Manager with weekend availability to implement utilization management and improve provider and member outcomes. You review services, apply criteria for appropriate care, refer to Health Coaching, and address quality issues while educating providers and members.

Required: ~3 years of clinical experience, RN licensure (state or multi-state via eNLC). Preferred: Bachelor’s Degree in Nursing.

Qualifications

• 3 years of related, progressive clinical experience in care management
• Current RN licensure (state or multi-state via eNLC)
• Bachelor’s Degree in Nursing preferred

Responsibilities

• Implement care management reviews aligning with standards and policies
• Ensure compliance with state and federal laws
• Refer members to Health Coaching/case management when appropriate
• Educate providers and vendors to streamline processes
• Use outcomes data to improve care management services
• Develop positive relationships with internal and external customers

Skills

Regulatory compliance

Multi-tasking

Communication skills

Data analysis

Team player

Organizational skills

Education

Bachelor’s Degree in Nursing

Tools

EHR systems

Job description

Highmark Health is seeking a full-time remote Care Manager with weekend availability to implement utilization management and improve provider and member outcomes. You review services, apply criteria for appropriate care, refer to Health Coaching, and address quality issues while educating providers and members.

Required: ~3 years of clinical experience, RN licensure (state or multi-state via eNLC). Preferred: Bachelor’s Degree in Nursing.