Remote RN Care Manager — Weekend Availability

Highmark Health; Iowa City (IA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Care Manager to implement utilization management strategies and oversee quality of care. The role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on education, data analysis, and collaboration with providers and members.

The ideal candidate has RN licensure (PA or eNLC), a nursing background, and experience in UM/CM/QA/Managed Care. The position offers a competitive salary and HIPAA-compliant workflow.

Qualifications

• RN licensure preferred (PA/ eNLC) and nursing background.
• 3 years of related clinical experience in UM/CM/QA/Managed Care.
• Bachelor’s degree in nursing preferred.

Responsibilities

• Implement care management reviews per criteria and policies.
• Ensure compliance with state and federal laws.
• Promote quality and efficiency in care management.
• Educate providers and members; reference data to improve outcomes.
• Refer members to Health Coaching or case management as needed.
• Collaborate with internal/external stakeholders to optimize processes.

Skills

Regulatory compliance knowledge

Written & verbal communication

Data analysis

Teamwork

Time management

Education

Bachelor’s Degree in Nursing

RN licensure (PA or eNLC)

Utilization Management Certification

Job description

Highmark Inc. is seeking a full-time remote Care Manager to implement utilization management strategies and oversee quality of care. The role requires weekend availability (Saturday and Sunday) plus three weekdays, with a focus on education, data analysis, and collaboration with providers and members.

The ideal candidate has RN licensure (PA or eNLC), a nursing background, and experience in UM/CM/QA/Managed Care. The position offers a competitive salary and HIPAA-compliant workflow.