Remote RN Care Manager — Weekend Availability

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

Job summary

Highmark Health is seeking a RN Case Manager for a full-time remote role requiring weekend availability (Saturday and Sunday) and three weekdays. The position focuses on utilization management strategies, care coordination, and identifying opportunities for Health Coaching and case management interventions.

Responsibilities include applying established criteria, promoting quality of care, educating providers, and collaborating with internal and external teams to optimize member outcomes.

Qualifications

• RN licensure in PA or multi-state via eNLC
• Bachelor's Degree in Nursing preferred
• 3 years of related clinical experience in the area of specialization
• Experience in a clinical setting

Responsibilities

• Implement care management review processes consistent with industry standards and the care manager's discipline.
• Ensure compliance with applicable state and federal laws and regulations.
• Carry out care management reviews per established criteria and guidelines.
• Promote quality and efficiency in care management services.
• Protect member privacy and share only information relevant to care.
• Refer members to Health Coaching/case management interventions when appropriate.
• Educate providers and vendors to streamline processes and build network relationships.
• Develop positive relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Perform other duties as assigned.

Skills

Regulatory compliance

Multitasking

Communication skills

Data analysis

Adaptable/flexible

Team player

Time management

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Health is seeking a RN Case Manager for a full-time remote role requiring weekend availability (Saturday and Sunday) and three weekdays. The position focuses on utilization management strategies, care coordination, and identifying opportunities for Health Coaching and case management interventions.

Responsibilities include applying established criteria, promoting quality of care, educating providers, and collaborating with internal and external teams to optimize member outcomes.