Remote RN Care Manager — Weekend Availability

Highmark Health; Atlanta (GA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a remote Care Manager to join our utilization management team.

This full-time role requires weekend availability (Saturday and Sunday) in addition to three weekdays and focuses on improving care quality and value for members. You will review services for appropriateness, apply established criteria, identify opportunities for referral to Health Coaching and case management, educate providers, and analyze outcomes to drive continuous improvement in care delivery and member

Qualifications

• Regulatory requirements knowledge and compliance.
• Experience with care management processes and criteria.
• Strong communication and analytical capabilities.

Responsibilities

• Implement care management reviews consistent with standards and policies.
• Promote quality and efficiency in care management delivery.
• Identify and refer members to Health Coaching/case management interventions.
• Educate providers and vendors to streamline processes and build network relationships.
• Use outcomes data to improve ongoing care management services.

Skills

Regulatory compliance

Multitasking

Written communication

Verbal communication

Data analysis

Team player

Analytical skills

Computer proficiency

Education

Bachelor’s Degree in Nursing

Tools

Healthcare software

Job description

Highmark Inc. is seeking a remote Care Manager to join our utilization management team.

This full-time role requires weekend availability (Saturday and Sunday) in addition to three weekdays and focuses on improving care quality and value for members. You will review services for appropriateness, apply established criteria, identify opportunities for referral to Health Coaching and case management, educate providers, and analyze outcomes to drive continuous improvement in care delivery and member