Remote RN Care Manager – Utilization & Outcomes

Highmark Health; Minneota (MN); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health in the United States is seeking a full-time remote Health Plan Nurse Care Manager with weekend availability (Saturday and Sunday) and three weekdays. This role executes utilization management, reviews care appropriateness, applies criteria, and identifies opportunities for Health Coaching and case management while monitoring provider and member satisfaction.

The ideal candidate holds a nursing degree, is licensed as an RN, has about 3 years of clinical experience, and is familiar

Qualifications

• RN with state licensure and current credentials.
• Minimum three years of related clinical experience.
• Experience in care management and utilization review preferred.
• Knowledge of HIPAA and privacy policies.
• Ability to work on weekends and remote? (not a requirement in description)

Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws.
• Practice within the scope of ethical principles.
• Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
• Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes.
• Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve ongoing care management services.
• Other duties as assigned or requested

Skills

Regulatory knowledge

Communication skills

Multitasking

Analytical skills

Team player

Time management

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Health in the United States is seeking a full-time remote Health Plan Nurse Care Manager with weekend availability (Saturday and Sunday) and three weekdays. This role executes utilization management, reviews care appropriateness, applies criteria, and identifies opportunities for Health Coaching and case management while monitoring provider and member satisfaction.

The ideal candidate holds a nursing degree, is licensed as an RN, has about 3 years of clinical experience, and is familiar