Remote RN Care Manager — Weekend Availability

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

Job summary

Highmark Inc. is seeking a full-time RN care manager for a remote role requiring Saturday and Sunday availability and three weekdays. The position focuses on utilization management, quality improvement, member education, and coordinating care with Health Coaches and care management teams.

Required is PA RN licensure or multi-state licensure via eNLC, with 3 years of clinical experience. Preferred are AMCM/Managed Care experience and a Bachelor’s in Nursing.

Qualifications

• Must be a licensed RN in PA or multi-state licensure via eNLC
• Minimum of 3 years of progressive clinical experience
• Experience in Utilization Management, Case Management, or Managed Care preferred

Responsibilities

• Implement care management reviews aligned with industry standards and care manager discipline.
• Ensure compliance with state and federal laws and regulatory requirements.
• Apply established criteria and guidelines to all care management reviews.
• Promote quality and efficiency in care management services.
• Protect the member's privacy and share only necessary information under the law.
• Identify members who could benefit from Health Coaching or care management.
• Educate providers and vendors to improve processes and strengthen relationships.
• Use outcomes data to improve care management services.
• Develop relationships with internal and external customers.

Skills

Regulatory compliance

Multi-tasking

Communication skills

Data analysis

Enthusiastic

Team player

Prioritize work

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a full-time RN care manager for a remote role requiring Saturday and Sunday availability and three weekdays. The position focuses on utilization management, quality improvement, member education, and coordinating care with Health Coaches and care management teams.

Required is PA RN licensure or multi-state licensure via eNLC, with 3 years of clinical experience. Preferred are AMCM/Managed Care experience and a Bachelor’s in Nursing.