Remote RN Care Manager: Utilization & Outcomes

Highmark Health; Nebraska; A distancia; USD 68.000 - 106.000; Jornada completa

Descripción de la vacante

Highmark Health is seeking a nurse with strong UM/CM background to lead care management reviews remotely, coordinating with providers and members. The role requires regulatory knowledge, data-driven decision making, and collaboration with health teams to improve outcomes.

The position emphasizes privacy, ethical practice, and ongoing education of stakeholders while supporting program efficiency and quality metrics.

Formación

• Current RN licensure in PA or multi-state via eNLC.
• Preferred Certification in Utilization Management or related field.
• Experience in UM/CM/QA/Managed Care is desirable.

Responsabilidades

• Implement care management reviews per standards and guidelines.
• Comply with state and federal laws and regulatory requirements.
• Apply criteria and policies to care management reviews.
• Promote quality and efficiency in care management services.
• Protect member privacy and handle information appropriately.
• Refer members to Health Coaching/case management when needed.
• Educate providers and vendors to streamline processes and build relationships.
• Maintain positive relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Perform other duties as assigned.

Conocimientos

Regulatory knowledge

Communication skills

Data analysis

Team player

Time management

Computer skills

Educación

Bachelor's Degree in Nursing

Descripción del empleo

Highmark Health is seeking a nurse with strong UM/CM background to lead care management reviews remotely, coordinating with providers and members. The role requires regulatory knowledge, data-driven decision making, and collaboration with health teams to improve outcomes.

The position emphasizes privacy, ethical practice, and ongoing education of stakeholders while supporting program efficiency and quality metrics.