Remote RN Care Manager – Utilization & Quality

Highmark Health; Beryl (WV); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is hiring for a full-time remote care management professional. The role requires weekend availability (Sat/Sun) and three weekdays, focusing on utilization management, quality improvement, and proactive member support.

The ideal candidate has ~3 years of clinical experience, an RN license (PA or multi-state via eNLC), and a Bachelor’s in Nursing. Strong communication, data analysis, and regulatory knowledge are essential.

Qualifications

• RN with progressive clinical experience in care management
• Experience in UM/CM/QA/Managed Care is preferred
• Excellent written and verbal communication; strong analytical skills

Responsibilities

• Implement care management review processes aligned with standards and policies
• Promote quality and efficiency in care management services
• Educate providers and members on care options and best practices
• Refer and collaborate to optimize member health outcomes

Skills

RN experience

Utilization Mgmt

Data analysis

Communication

Regulatory compliance

Team player

Education

Bachelor's Degree in Nursing

Job description

Highmark Health is hiring for a full-time remote care management professional. The role requires weekend availability (Sat/Sun) and three weekdays, focusing on utilization management, quality improvement, and proactive member support.

The ideal candidate has ~3 years of clinical experience, an RN license (PA or multi-state via eNLC), and a Bachelor’s in Nursing. Strong communication, data analysis, and regulatory knowledge are essential.