Remote RN Care Manager: Utilization & Outcomes

Highmark Health; Lorida (FL); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking an experienced Care Manager (RN) for a full-time remote role requiring weekend availability.

The position focuses on utilization management, review of care appropriateness, and referrals to Health Coaching or case management. Responsibilities include implementing care management reviews, ensuring regulatory compliance, educating providers and members, and developing strategies to improve outcomes.

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• RN licensure (PA) or eNLC multi-state licensure required depending on where care is provided.

Responsibilities

• Implement care management review processes aligned with industry and corporate standards.
• Ensure compliance with state and federal laws and regulatory requirements.
• Execute care management reviews according to established criteria and medical policies.
• Promote quality and efficiency in care management services.
• Respect patient privacy and share information only as permitted by law.
• Refer members to Health Coaching/case management when appropriate.
• Educate providers and vendors to streamline processes and build network relations.
• Develop positive working relationships with internal and external stakeholders.
• Use outcomes data to improve care management services.

Skills

Care management

Regulatory compliance

Communication skills

Data analysis

Privacy & ethics

Team collaboration

Multitasking

Time management

Education

Bachelor's degree in nursing

Job description

Highmark Inc. is seeking an experienced Care Manager (RN) for a full-time remote role requiring weekend availability.

The position focuses on utilization management, review of care appropriateness, and referrals to Health Coaching or case management. Responsibilities include implementing care management reviews, ensuring regulatory compliance, educating providers and members, and developing strategies to improve outcomes.