Remote RN Care Manager — Weekend Availability

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

Job summary

Highmark Health is seeking a full-time remote Care Manager with weekend availability (Saturday and Sunday) and three weekdays. You will implement utilization management strategies, review service appropriateness, and identify opportunities for referral to Health Coaching or case management to enhance outcomes.

The role requires an RN license (PA or multi-state via eNLC) and ~3 years of related clinical experience.

Qualifications

• RN license required (PA or multi-state via eNLC)
• ~3 years clinical experience in the specialty
• UM/CM/QA/Managed Care experience preferred
• Experience with acute inpatient and post-acute settings is a plus

Responsibilities

• Implement care management reviews per established criteria and policies
• Ensure compliance with state/federal laws and regulations
• Refer members to Health Coaching/case management when appropriate
• Promote quality and efficiency in care management services
• Educate providers and members to improve outcomes and satisfaction
• Maintain privacy and professional ethics in all interactions

Skills

Regulatory knowledge

Compliance

Multitasking

Communication skills

Data analysis

Team player

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time remote Care Manager with weekend availability (Saturday and Sunday) and three weekdays. You will implement utilization management strategies, review service appropriateness, and identify opportunities for referral to Health Coaching or case management to enhance outcomes.

The role requires an RN license (PA or multi-state via eNLC) and ~3 years of related clinical experience.