Remote RN Care Manager - Utilization & Outcomes

Highmark Health; Sioux Center (IA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a Remote Care Manager with full-time commitment, weekend availability (Sat/Sun) plus three weekdays. You will implement utilization management strategies, review appropriateness of care, and coordinate with Health Coaching and case management to improve member outcomes.

Requires RN licensure, 3 years of clinical experience, and a Bachelor’s in Nursing preferred. Strong data analysis, communication, and regulatory knowledge essential; operates within HIPAA guidelines and

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• RN licensure and regulatory compliance.

Responsibilities

• Implement care management review processes that are aligned with industry standards.
• Ensure compliance with state and federal laws and regulations.
• Apply criteria and guidelines for care management reviews and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy and ensure information sharing is compliant.

Skills

Regulatory knowledge

Multi-tasking

Communication skills

Data analysis

Adaptability

Team player

Prioritization

Computer skills

Education

Bachelor's Degree in Nursing

3 years clinical experience

Job description

Highmark Inc. is seeking a Remote Care Manager with full-time commitment, weekend availability (Sat/Sun) plus three weekdays. You will implement utilization management strategies, review appropriateness of care, and coordinate with Health Coaching and case management to improve member outcomes.

Requires RN licensure, 3 years of clinical experience, and a Bachelor’s in Nursing preferred. Strong data analysis, communication, and regulatory knowledge essential; operates within HIPAA guidelines and