Remote RN Care Manager | Weekend Availability

Highmark Health; Arkansas; À distance; USD 68 000 - 106 000; Plein temps

Résumé du poste

Highmark Health is seeking a qualified nurse to join its care management team in a REMOTE role requiring weekend availability (Sat and Sun) plus three weekdays. The position focuses on utilization management, coordinating care, coaching, and improving member outcomes across settings.

The role emphasizes adherence to regulatory standards, data-driven improvement, and collaboration with providers, vendors, and internal teams to ensure high-quality care and efficient service delivery.

Qualifications

• Current State of PA RN licensure OR current multi-state licensure through the eNLC.
• Bachelor’s degree in Nursing preferred.
• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• 3 years RN experience; RN Case Management / Care Management desirable.
• Experience in UM/CM/QA/Managed Care and in acute inpatient and post-acute settings.
• Certification in Utilization Management or related field preferred.
• Knowledge of regulatory and compliance guidelines and medical policies.

Responsabilités

• Implement care management review processes per standards and discipline.
• Comply with state and federal laws and regulatory requirements.
• Execute care reviews using established criteria and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy within legal requirements.
• Practice within ethical principles.
• Identify and refer members for Health Coaching/case management when needed.
• Collaborate to maximize member health outcomes and streamline processes.
• Educate providers and vendors to improve processes and relationships.
• Develop positive relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Perform other duties as assigned.

Connaissances

Regulatory knowledge

Multitask in fast-paced

Written and verbal communication

Data analysis

Enthusiastic and flexible

Team player

Prioritize workload

Computer skills

Formation

Bachelor's Degree in Nursing

Description du poste

Highmark Health is seeking a qualified nurse to join its care management team in a REMOTE role requiring weekend availability (Sat and Sun) plus three weekdays. The position focuses on utilization management, coordinating care, coaching, and improving member outcomes across settings.

The role emphasizes adherence to regulatory standards, data-driven improvement, and collaboration with providers, vendors, and internal teams to ensure high-quality care and efficient service delivery.