Remote RN Care Manager – Utilization & Health Coaching

Highmark Health; Montana; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is hiring a full-time RN for a REMOTE position requiring weekend availability (Saturday and Sunday) in addition to three weekdays. The role implements utilization management strategies, reviews care services, and refers eligible members to Health Coaching and case management.

Preferred is a Bachelor’s Degree in Nursing. Candidates should have 3 years of related clinical experience and an RN license (PA or multi-state via eNLC).

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.

Responsibilities

• Implement care management review processes per standards and care manager discipline.
• Ensure compliance with state and federal laws and regulations.
• Apply established criteria and guidelines for care management reviews.
• Promote quality and efficiency in care management services.
• Protect patient privacy within legal requirements.
• Refer members to Health Coaching/case management when appropriate.
• Collaborate to improve care outcomes and engage network providers.
• Educate providers and vendors to streamline processes and build relationships.
• Develop positive relationships with internal and external customers.
• Use outcomes data to improve services.

Skills

Regulatory knowledge

Multitasking

Communication

Data analysis

Team player

Time management

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Health is hiring a full-time RN for a REMOTE position requiring weekend availability (Saturday and Sunday) in addition to three weekdays. The role implements utilization management strategies, reviews care services, and refers eligible members to Health Coaching and case management.

Preferred is a Bachelor’s Degree in Nursing. Candidates should have 3 years of related clinical experience and an RN license (PA or multi-state via eNLC).