Remote RN Care Manager: Utilization & Health Coaching

Highmark Health; East Honolulu (HI); Teletrabalho; USD 68 000 - 106 000; Tempo integral

Resumo da oferta

Highmark Health is seeking a full-time RN for a remote role requiring weekend availability (Saturday and Sunday) and three weekdays. The position focuses on utilization management, care management reviews, and improving provider and member satisfaction.

Responsibilities include applying care management criteria, educating providers, and utilizing outcomes data to enhance care delivery. Requirements include 3 years of clinical experience and PA RN licensure with eNLC where applicable.

Qualificações

• Excellent written and verbal communication skills.
• Ability to multi task and perform in a fast paced environment.
• Be a team player who possesses strong analytical and organizational skills.
• Demonstrated ability to prioritize work demands and meet deadlines.
• Excellent computer and software knowledge.

Responsabilidades

• Implement care management review processes per established standards.
• Ensure compliance with state and federal laws.
• Execute care management reviews per guidelines and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy within legal boundaries.
• Identify and refer members to Health Coaching/case management.
• Educate providers and vendors to streamline processes.
• Develop relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Other duties as assigned or requested.

Conhecimentos

Regulatory knowledge

Communication skills

Multitasking

Team player

Data analysis

Organization

Computer skills

Formação académica

Bachelor's Degree in Nursing

Descrição da oferta de emprego

Highmark Health is seeking a full-time RN for a remote role requiring weekend availability (Saturday and Sunday) and three weekdays. The position focuses on utilization management, care management reviews, and improving provider and member satisfaction.

Responsibilities include applying care management criteria, educating providers, and utilizing outcomes data to enhance care delivery. Requirements include 3 years of clinical experience and PA RN licensure with eNLC where applicable.