Remote RN Care Manager - Utilization & Health Coaching

Highmark Health; Jackson (MS); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time remote Care Manager to implement utilization management strategies. The role requires weekend availability and weekday coverage to review care, apply criteria, and refer to Health Coaching when appropriate, while ensuring privacy and compliance.

The position emphasizes analyzing data to improve provider performance and member satisfaction, educating providers, and coordinating with internal and external stakeholders to optimize care delivery.

Qualifications

• Current State of PA RN licensure or multi-state licensure via eNLC.
• 3 years of related, progressive clinical experience.
• Experience in UM/CM/QA/Managed Care.
• Experience with acute inpatient and post-acute care.

Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted criteria and policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect member privacy and share only information relevant to care.
• Practice within ethical principles.
• Identify and refer members for Health Coaching/case management interventions.
• Collaborate to optimize member health outcomes and develop network relationships.
• Educate providers and vendors to streamline processes and improve relations.
• Develop and sustain positive working relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Perform other duties as assigned.

Skills

Regulatory knowledge

Communication skills

Data analysis

Team player

Time management

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time remote Care Manager to implement utilization management strategies. The role requires weekend availability and weekday coverage to review care, apply criteria, and refer to Health Coaching when appropriate, while ensuring privacy and compliance.

The position emphasizes analyzing data to improve provider performance and member satisfaction, educating providers, and coordinating with internal and external stakeholders to optimize care delivery.