Remote RN Care Manager Weekend Availability

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

Job summary

Highmark Health, a remote Care Manager role in the United States, requires weekend availability (Saturday and Sunday) plus three weekdays to implement utilization management and care coordination. You will review service appropriateness, apply criteria, and refer to Health Coaching as needed, while monitoring provider and member satisfaction.

The position emphasizes data-driven improvements, privacy, and collaboration with internal and external stakeholders to optimize care delivery.

Qualifications

• 3 years of related clinical experience in care management or UM/CM/QA/Managed Care
• RN licensure in PA or via eNLC; Bachelor's in Nursing preferred
• Strong communication and data analysis skills

Responsibilities

• Implement care management review processes per guidelines
• Ensure compliance with state, federal laws and policies
• Refer members to Health Coaching/case management when appropriate
• Promote quality and efficiency in care management
• Educate providers and members to improve outcomes
• Develop relationships with internal and external customers

Skills

Care management

Health coaching

Data analysis

Regulatory compliance

Quality improvement

Communication

Team player

Multitasking

Computer skills

Education

Bachelor's Degree in Nursing

RN licensure (PA or eNLC multi-state)

Job description

Highmark Health, a remote Care Manager role in the United States, requires weekend availability (Saturday and Sunday) plus three weekdays to implement utilization management and care coordination. You will review service appropriateness, apply criteria, and refer to Health Coaching as needed, while monitoring provider and member satisfaction.

The position emphasizes data-driven improvements, privacy, and collaboration with internal and external stakeholders to optimize care delivery.