Remote RN Care Manager: Weekend Availability

Highmark Health; Milton (MA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time RN for remote utilization management and care management. The role requires weekend availability (Saturday and Sunday) plus three weekdays, with duties spanning review of care appropriateness, application of criteria, and referral to Health Coaching as needed.

The ideal candidate has ~3 years of clinical experience, RN licensure (PA or multi-state via eNLC), and strong communication, analytical, and teamwork skills. Preference for UM/CM/QA experience.

Qualifications

• Bachelor’s degree in nursing required or equivalent.
• 3 years of related clinical experience in the area of specialization.
• RN experience preferred or active RN license in PA or multi-state licensure via eNLC.
• Certification in Utilization Management or related field preferred.

Responsibilities

• Implement care management review processes in line with industry standards and regulations.
• Promote quality and efficiency in care management services.
• Educate providers and members on utilization management and care options.
• Identify members who could benefit from Health Coaching/case management interventions.
• Utilize outcomes data to improve care management services.

Skills

Communication skills

Multi-tasking

Team player

Analytical thinking

Organizational skills

Written and verbal communication

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time RN for remote utilization management and care management. The role requires weekend availability (Saturday and Sunday) plus three weekdays, with duties spanning review of care appropriateness, application of criteria, and referral to Health Coaching as needed.

The ideal candidate has ~3 years of clinical experience, RN licensure (PA or multi-state via eNLC), and strong communication, analytical, and teamwork skills. Preference for UM/CM/QA experience.