Remote RN Care Manager — Utilization & Health Coaching

Highmark Health; Juneau (AK); A distancia; USD 68.000 - 106.000; Jornada completa

Descripción de la vacante

Highmark Inc. is seeking a full-time remote Care Manager responsible for utilization management, reviewing care appropriateness, and identifying opportunities for Health Coaching interventions. The role involves utilizing data to improve member and provider outcomes and collaborating across teams.

The position requires regulatory knowledge, strong communication, and the ability to manage multiple tasks in a fast-paced environment, with weekend availability as needed.

Formación

• Licensure required or preferred per job specs.
• Bachelor's degree in nursing preferred for clinical leadership roles.

Responsabilidades

• Implement care management reviews per industry standards.
• Ensure compliance with state and federal laws.
• Apply approved guidelines and medical policies for reviews.
• Promote quality and efficiency in care management services.
• Respect privacy and only share information relevant to care.
• Identify members who may benefit from Health Coaching or case management.
• Collaborate to streamline processes and engage providers.
• Educate providers and vendors to improve workflows and network relationships.
• Develop positive relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Perform other duties as assigned.

Conocimientos

Regulatory compliance

Multi-tasking

Verbal communication

Written communication

Data analysis

Team player

Analytical skills

Prioritization

Software proficiency

Educación

Bachelor’s Degree in Nursing

RN licensure (PA RN or eNLC)

Descripción del empleo

Highmark Inc. is seeking a full-time remote Care Manager responsible for utilization management, reviewing care appropriateness, and identifying opportunities for Health Coaching interventions. The role involves utilizing data to improve member and provider outcomes and collaborating across teams.

The position requires regulatory knowledge, strong communication, and the ability to manage multiple tasks in a fast-paced environment, with weekend availability as needed.