Remote RN Care Manager: Utilization & Outcomes

Highmark Health; Muncie (IN); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. in the United States is seeking a full-time RN for a remote care management role, requiring weekend availability (Sat/Sun) and three weekdays.

You will review services, apply utilization criteria, and coordinate with Health Coaching and case management to optimize care. You will educate providers, monitor outcomes data, ensure privacy, and develop strategies to improve provider and member satisfaction.

Qualifications

• Bachelor's degree in nursing is preferred; RN licensure required in PA or eNLC states.
• Minimum 3 years of progressive clinical experience in the area.
• Experience in clinical settings and care management preferred.

Responsibilities

• Implement care management review processes per industry standards.
• Ensure compliance with state and federal laws.
• Follow criteria and guidelines for care management reviews.
• Promote quality and efficiency in care management.
• Protect member privacy under HIPAA and relevant laws.
• Identify and refer members to Health Coaching/case management.
• Collaborate to improve provider resources and network relationships.
• Educate providers and vendors to streamline processes.
• Develop positive relationships with internal and external customers.
• Utilize outcomes data to improve care management.
• Perform other duties as assigned.

Skills

Regulatory compliance

Data analysis

Excellent communication

Multi-tasking

Time management

Team collaboration

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. in the United States is seeking a full-time RN for a remote care management role, requiring weekend availability (Sat/Sun) and three weekdays.

You will review services, apply utilization criteria, and coordinate with Health Coaching and case management to optimize care. You will educate providers, monitor outcomes data, ensure privacy, and develop strategies to improve provider and member satisfaction.