Remote RN Care Manager & Utilization Specialist

Highmark Health; Nevada; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time remote Care Manager with weekend availability (Saturday and Sunday) and three weekdays. You will implement care management reviews, apply established criteria for resource use, and identify opportunities for Health Coaching referrals.

You will monitor care delivery, educate providers and members, and analyze data to improve outcomes. Respond to customer inquiries with proactive interventions and alternatives, and collaborate to sustain high-quality,

Qualifications

• Registered nurse (RN) with active licensure in the relevant state.
• Experience in care management, utilization review, or managed care preferred.
• Demonstrated ability to analyze data and apply policy/regulatory guidelines.

Responsibilities

• Implement care management reviews per established criteria and policies.
• Promote quality and efficiency in care management services.
• Educate providers and members on care options and interventions.
• Refer members to Health Coaching/case management as appropriate.
• Maintain privacy and comply with applicable laws during care delivery.

Skills

Regulatory knowledge

Multi-tasking

Communication skills

Data analysis

Team player

Prioritization

Computer skills

Education

Bachelor’s Degree in Nursing

Tools

Office software

Job description

Highmark Health is seeking a full-time remote Care Manager with weekend availability (Saturday and Sunday) and three weekdays. You will implement care management reviews, apply established criteria for resource use, and identify opportunities for Health Coaching referrals.

You will monitor care delivery, educate providers and members, and analyze data to improve outcomes. Respond to customer inquiries with proactive interventions and alternatives, and collaborate to sustain high-quality,