Remote RN Care Manager - Utilization & Health Coaching

Highmark Health; Oklahoma City (OK); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time RN Care Manager for a remote role requiring weekend availability and three weekdays. The role focuses on utilization management, applying criteria for appropriate healthcare services, and identifying opportunities for referral to Health Coaching and case management.

You will monitor and analyze care delivery, educate providers and members, and respond to inquiries with interventions to improve outcomes and satisfaction.

Qualifications

• Knowledge of regulatory and compliance guidelines and medical policies.
• Ability to multi-task in a fast-paced environment.
• Excellent written and verbal communication skills.
• Ability to analyze data, measure outcomes, and develop action plans.

Responsibilities

• Implement care management review processes per established criteria and policies.
• Comply with state and federal laws and regulatory requirements.
• Conduct care management reviews and apply accepted guidelines.
• Promote quality and efficiency in care management services.
• Protect member privacy and adhere to privacy laws.
• Refer members to Health Coaching/case management when appropriate.
• Educate providers and vendors to streamline processes and build relationships.
• Develop relationships with internal and external customers and collaborate across teams.
• Utilize outcomes data to improve care management services.

Skills

Regulatory knowledge

Multi-tasking

Written & verbal comms

Data analysis

Team collaboration

Analytical & organizational skills

Education

Bachelor’s Degree in Nursing

RN licensure

Job description

Highmark Health is seeking a full-time RN Care Manager for a remote role requiring weekend availability and three weekdays. The role focuses on utilization management, applying criteria for appropriate healthcare services, and identifying opportunities for referral to Health Coaching and case management.

You will monitor and analyze care delivery, educate providers and members, and respond to inquiries with interventions to improve outcomes and satisfaction.