Remote RN Care Manager: Utilization & Health Coaching

Highmark Health; Colorado Springs (CO); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Care Manager to implement utilization management, review services, and identify opportunities for Health Coach referrals. The role requires weekend availability (Sat/Sun) plus three weekdays and focuses on improving provider and member satisfaction.

You will educate providers, analyze data, ensure regulatory compliance, and develop action plans. RN licensure (PA) or eNLC and 3 years of clinical experience are preferred.

Qualifications

• Required- 3 years of related, progressive clinical experience in the area of specialization; Experience in a clinical setting.
• Preferred: 3 years RN experience; RN Case Management, Care Management; UM/CM/QA/Managed Care; Experience with acute inpatient and post-acute; Experience with skilled nursing, inpatient Rehab

Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws.
• Practice within the scope of ethical principles.
• Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
• Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member.
• Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve ongoing care management services.
• Other duties as assigned or requested

Skills

Regulatory compliance

Multi-tasking

Written & verbal

Data analysis

Innovative thinking

Team player

Time management

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Care Manager to implement utilization management, review services, and identify opportunities for Health Coach referrals. The role requires weekend availability (Sat/Sun) plus three weekdays and focuses on improving provider and member satisfaction.

You will educate providers, analyze data, ensure regulatory compliance, and develop action plans. RN licensure (PA) or eNLC and 3 years of clinical experience are preferred.