Remote RN Care Manager - Weekend Availability

Highmark Health; Maryland City (MD); Remote; USD 68.000 - 106.000; Vollzeit

Zusammenfassung

Highmark Inc. is seeking a full-time remote Care Management professional. The role requires weekend availability (Saturday and Sunday) in addition to three weekdays and focuses on utilization management, care coordination, and quality improvement.

You will review service appropriateness, apply criteria, refer to Health Coaching or case management, and address quality issues. Strong regulatory knowledge and data analysis are essential.

Qualifikationen

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• Current PA RN licensure or multi-state licensure through eNLC.
• Certification in Utilization Management or related field (preferred).

Aufgaben

• Implement care management review processes that are consistent with established industry and corporate standards.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted criteria and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect the member’s privacy, sharing only information relevant to the member’s care and within legal bounds.
• Practice within ethical principles.
• Identify and refer members suitable for Health Coaching/case management interventions.
• Employ collaborative interventions to maximize health care outcomes and know provider resources.
• Educate providers and vendors to streamline processes and develop network rapport.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve care management services.
• Other duties as assigned or requested

Kenntnisse

Regulatory knowledge

Multitasking

Written and verbal communication

Data analysis

Team player

Time management

Computer skills

Ausbildung

Bachelor's Degree in Nursing

Tools

Jobbeschreibung

Highmark Inc. is seeking a full-time remote Care Management professional. The role requires weekend availability (Saturday and Sunday) in addition to three weekdays and focuses on utilization management, care coordination, and quality improvement.

You will review service appropriateness, apply criteria, refer to Health Coaching or case management, and address quality issues. Strong regulatory knowledge and data analysis are essential.