Remote RN Care Manager – Weekend Availability

Highmark Health; Central City (NE); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a remote care management professional. The role requires weekend availability (Saturday and Sunday) plus three weekdays, overseeing utilization management and care coordination to improve provider and member outcomes.

Responsibilities include implementing reviews, ensuring regulatory compliance, educating providers, and identifying opportunities for coaching or referral. A RN license with 3+ years of clinical care management is preferred.

Qualifications

• RN required with current PA license or multi-state licensure per iNLC.
• 3+ years of clinical experience in care management or relevant area.
• Experience in a clinical setting and health care environment.
• Preferred RN Case Management, UM/CM/QA experience.

Responsibilities

• Implement care management reviews consistent with standards.
• Ensure compliance with state/federal laws and policies.
• Refer members to Health Coaching/case management as needed.
• Educate providers and vendors to streamline processes.
• Develop relationships with internal and external customers.

Skills

Care management

Statistics/data analysis

Communication skills

HIPAA compliance

Multi-tasking

Team player

Office software

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a remote care management professional. The role requires weekend availability (Saturday and Sunday) plus three weekdays, overseeing utilization management and care coordination to improve provider and member outcomes.

Responsibilities include implementing reviews, ensuring regulatory compliance, educating providers, and identifying opportunities for coaching or referral. A RN license with 3+ years of clinical care management is preferred.