Remote RN Care Manager | Utilization & Health Coaching

Highmark Health; Manchester (NH); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time REMOTE Care Management professional with weekend availability to coordinate utilization management and health coaching.

You will review services for appropriateness, apply criteria, analyze data, and educate providers and members to improve outcomes and satisfaction. Required 3 years of progressive clinical experience; RN licensure in PA or multi-state licensure, and a Bachelor’s Degree in Nursing is preferred.

Qualifications

• Working knowledge of pertinent regulatory and compliance guidelines and medical policies
• Ability to multi task and perform in a fast paced and often intense environment
• Excellent written and verbal communication skills
• Ability to analyze data, measure outcomes, and develop action plans
• Be enthusiastic, innovative, and flexible
• 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 and skills

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.

Skills

Regulatory knowledge

Multi-tasking

Communication skills

Data analysis

Adaptability

Team player

Time management

Computers & software

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time REMOTE Care Management professional with weekend availability to coordinate utilization management and health coaching.

You will review services for appropriateness, apply criteria, analyze data, and educate providers and members to improve outcomes and satisfaction. Required 3 years of progressive clinical experience; RN licensure in PA or multi-state licensure, and a Bachelor’s Degree in Nursing is preferred.