Remote RN Care Manager (Weekend Availability)

Highmark Health; Crystal Bay (NV); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Utilization Management professional to lead care management reviews, ensure policy compliance, and collaborate with providers and health plans. The role emphasizes quality, privacy, and outcome-driven improvements across both inpatient and outpatient settings.

Required RN licensure with alignment to state regulations; preferred BSN and 3+ years in UM/CM/QA. The position demands weekend availability and weekday coverage within a remote work model.

Qualifications

• Regulatory and compliance knowledge related to health care policies.
• Ability to analyze data and measure outcomes to improve care management.
• Strong written and verbal communication skills.
• Capability to multitask in a fast-paced environment.
• Analytical thinking with organizational skills.
• Team-oriented with collaborative approach.
• Proficient computer and software skills.

Responsibilities

• Implement care management reviews following established criteria and policies.
• Ensure compliance with state, federal laws and regulatory standards.
• Carry out care management reviews per guidelines and medical policies.
• Promote quality and efficiency in care management services.
• Protect member privacy and share only information necessary for care.
• Educate providers and vendors to streamline processes and build relationships.
• Develop positive relationships with internal and external customers.
• Use outcomes data to improve care management programs.
• Perform additional duties as assigned.

Skills

Regulatory compliance

Data analysis

Communication skills

Multi-tasking

Analytical skills

Team player

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a remote Utilization Management professional to lead care management reviews, ensure policy compliance, and collaborate with providers and health plans. The role emphasizes quality, privacy, and outcome-driven improvements across both inpatient and outpatient settings.

Required RN licensure with alignment to state regulations; preferred BSN and 3+ years in UM/CM/QA. The position demands weekend availability and weekday coverage within a remote work model.