Remote RN Care Manager | Utilization & Health Coaching

Highmark Health; Wyoming (MI); À distance; USD 68 000 - 106 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a remote RN Case Manager to implement utilization management strategies and coordinate care across the health system.

The role requires weekend availability (Saturday and Sunday) in addition to three weekdays, and involves reviewing service appropriateness, applying criteria, and identifying opportunities for referrals to Health Coaching or case management. Qualified candidates hold an RN license (PA) or multi-state license via eNLC, and typically have 3 years of related

Qualifications

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

Responsabilités

• Implement care management review processes.
• Ensure compliance with state and federal laws.
• Apply criteria and policies to care reviews.
• Promote quality and efficiency in care management.
• Protect member privacy and data.
• Refer members to Health Coaching/case management when appropriate.
• Collaborate with providers and vendors to improve processes.
• Develop and sustain relationships with internal/external customers.
• Use outcomes data to improve services.

Connaissances

Regulatory compliance

Multitasking

Communication

Data analysis

Team player

Organizational skills

Formation

Bachelor's Degree in Nursing

Description du poste

Highmark Inc. is seeking a remote RN Case Manager to implement utilization management strategies and coordinate care across the health system.

The role requires weekend availability (Saturday and Sunday) in addition to three weekdays, and involves reviewing service appropriateness, applying criteria, and identifying opportunities for referrals to Health Coaching or case management. Qualified candidates hold an RN license (PA) or multi-state license via eNLC, and typically have 3 years of related