Remote RN Care Manager — Weekend Availability

Highmark Health; Bastrop (LA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Care Management professional to oversee utilization management and care coordination initiatives. The role requires weekend availability (Saturday and Sunday) plus three weekdays, with responsibilities including review of care appropriateness, applying guidelines, and identifying opportunities for referral to Health Coaching/case management.

Qualified candidates will have ~3 years of clinical experience, RN licensure (or multi-state eNLC), and a Bachelor’s in

Qualifications

• 3 years of related clinical experience in health care.
• RN experience preferred.
• Current RN licensure or multi-state license (eNLC) required.
• Certification in Utilization Management preferred.

Responsibilities

• Implement care management reviews per criteria and policies.
• Promote quality and efficiency in care management.
• Educate providers and members on care strategies.
• Refer members to Health Coaching and case management as needed.
• Ensure privacy and comply with laws and regulations.
• Utilize outcomes data to improve services.
• Collaborate with internal and external customers.

Skills

Care management

Healthcare regulations

Data analysis

Communication

Team collaboration

Privacy & compliance

Multi-tasking

Education

RN licensure

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a remote Care Management professional to oversee utilization management and care coordination initiatives. The role requires weekend availability (Saturday and Sunday) plus three weekdays, with responsibilities including review of care appropriateness, applying guidelines, and identifying opportunities for referral to Health Coaching/case management.

Qualified candidates will have ~3 years of clinical experience, RN licensure (or multi-state eNLC), and a Bachelor’s in