Remote RN Care Manager - Utilization & Outcomes

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

Job summary

Highmark Health is seeking a dedicated RN-based care management professional for a full-time remote role requiring weekend availability. The role focuses on utilization management, aligning care with policies, and guiding members to Health Coaching and case management options. Strong data interpretation and education of providers are essential.

The position emphasizes privacy, compliance, and collaboration with internal teams to improve member satisfaction and outcomes across a remote workflow.

Qualifications

• Knowledge of regulatory and compliance guidelines and medical policies.
• Ability to analyze qualitative and quantitative data to improve care.
• Strong written and verbal communication; teamwork.
• Protect patient privacy and handle PHI per laws and policies.

Responsibilities

• Implement care management review processes aligned with standards and policies.
• Ensure compliance with state and federal laws in all care management activities.
• Execute care management reviews per established criteria and guidelines.
• Promote quality and efficiency in care management services.
• Respect patient privacy and share information only when appropriate.
• Identify and refer members for Health Coaching/case management as needed.
• Educate providers and vendors to improve processes and relationships.
• Develop positive relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Perform other duties as assigned.

Skills

Regulatory compliance knowledge

Data analysis

Communication skills

Privacy and PHI handling

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a dedicated RN-based care management professional for a full-time remote role requiring weekend availability. The role focuses on utilization management, aligning care with policies, and guiding members to Health Coaching and case management options. Strong data interpretation and education of providers are essential.

The position emphasizes privacy, compliance, and collaboration with internal teams to improve member satisfaction and outcomes across a remote workflow.