Remote RN Care Manager – Utilization & Health Coaching

Highmark Health; Montpelier (VT); Remote; USD 68.000 - 106.000; Vollzeit

Zusammenfassung

Highmark Inc. is seeking a full-time remote RN Care Manager with weekend availability. The role emphasizes utilization management, applying criteria to ensure appropriate care, and identifying opportunities for Health Coaching and case management.

You will monitor care delivery, educate providers, and analyze data to improve member outcomes. Required 3 years of clinical experience, RN licensure (PA or multi-state via eNLC), and preferred Bachelor’s in Nursing.

Qualifikationen

• RN with at least 3 years in care management or similar clinical setting.
• Experience in UM/CM/QA/Managed Care and post-acute care.
• Current RN licensure (PA) or multi-state via eNLC.

Aufgaben

• Implement care management review processes per standards and guidelines.
• Ensure compliance with state and federal laws and policies.
• Refer members to Health Coaching/case management as needed.
• Educate providers and vendors to improve processes and relationships.
• Use outcomes data to improve care management services.
• Maintain privacy and ethical handling of member information.
• Collaborate with internal/external customers to sustain relationships.

Kenntnisse

Regulatory knowledge

Multi-tasking

Written & verbal communication

Data analysis

Team player

Analytical skills

Organizational skills

Ausbildung

Bachelor’s Degree in Nursing

Jobbeschreibung

Highmark Inc. is seeking a full-time remote RN Care Manager with weekend availability. The role emphasizes utilization management, applying criteria to ensure appropriate care, and identifying opportunities for Health Coaching and case management.

You will monitor care delivery, educate providers, and analyze data to improve member outcomes. Required 3 years of clinical experience, RN licensure (PA or multi-state via eNLC), and preferred Bachelor’s in Nursing.