Remote RN Care Manager: Utilization & Health Coaching

Highmark Health; Helena (MT); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time RN Care Manager for a REMOTE role requiring weekend availability (Saturday and Sunday) and three weekdays. This position centers on utilization management, applying criteria, and coordinating with Health Coach/case management to improve member and provider outcomes.

Requirements include RN licensure (PA or eligible for eNLC) and a preferred Bachelor’s in Nursing, with at least 3 years of clinical experience and UM/CM/QA exposure.

Qualifications

• RN licensure in PA or eligible for eNLC.
• Bachelor’s degree in Nursing preferred.
• Experience in UM/CM/QA/Managed Care is desirable.

Responsibilities

• Implement care management reviews per criteria and policies.
• Promote quality and efficiency in care management services.
• Educate providers and members on care management principles.
• Identify and refer members to Health Coaching/case management.
• Protect privacy and comply with applicable laws.
• Develop relationships with internal and external customers.
• Use outcomes data to improve services.
• Respond to inquiries and provide interventions.

Skills

Regulatory compliance knowledge

Excellent written and verbal skills

Data analysis and outcomes tracking

Multitasking in fast-paced settings

Strong analytical and organizational能力

Meeting deadlines and prioritization

Education

Bachelor's Degree in Nursing

Job description

Highmark Health is seeking a full-time RN Care Manager for a REMOTE role requiring weekend availability (Saturday and Sunday) and three weekdays. This position centers on utilization management, applying criteria, and coordinating with Health Coach/case management to improve member and provider outcomes.

Requirements include RN licensure (PA or eligible for eNLC) and a preferred Bachelor’s in Nursing, with at least 3 years of clinical experience and UM/CM/QA exposure.