Remote RN Care Manager — Utilization & Outcomes

Highmark Health

Kansas

Remote

USD 68,000 - 106,000

Full time

6 days ago

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Job summary

Highmark Health is seeking a full-time remote RN-focused Care Manager to implement utilization management strategies and coordinate care across the network. The role requires weekend availability (Saturday and Sunday) plus three weekdays, and emphasizes adherence to privacy, policy, and regulatory standards.

The ideal candidate has ~3 years of clinical RN experience, knowledge of UM/CM/QA/Managed Care, and licensure in PA or multi-state via eNLC, with strong data analysis and communication

Qualifications

RN licensure (PA or multi-state via eNLC) may be required.
Bachelor’s Degree in Nursing preferred.
Approximately 3 years of clinical RN experience.
Experience in UM/CM/QA/Managed Care recommended.

Responsibilities

Implement care management reviews per standards and policy.
Ensure compliance with laws and regulations.
Apply established criteria for care management reviews.
Promote quality and efficiency in care services.
Protect member privacy and data.
Refer members to Health Coaching/case management as needed.
Educate providers and vendors to improve processes.
Maintain positive relationships with customers.
Use outcomes data to improve services.
Perform other duties as assigned.

Skills

Regulatory compliance

Multitasking

Communication skills

Data analysis

Adaptable

Team player

Priority management

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

The ideal candidate has ~3 years of clinical RN experience, knowledge of UM/CM/QA/Managed Care, and licensure in PA or multi-state via eNLC, with strong data analysis and communication

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