Remote RN Care Manager – Weekend Availability

Highmark Health; Montgomery (AL); Teletrabalho; USD 68 000 - 106 000; Tempo integral

Resumo da oferta

Highmark Inc. is seeking a full-time remote RN case manager with weekend availability (Sat/Sun) and three weekdays. Responsibilities include reviewing care appropriateness, applying criteria for resource use, and coordinating with Health Coaches and case management to improve provider and member outcomes.

The role emphasizes privacy, ethical practice, and proactive analysis to enhance service quality. Requires active RN licensure and 3 years of relevant clinical experience.

Qualificações

• Current State of PA RN licensure or multi-state licensure via eNLC.
• Preferred Bachelor’s Degree in Nursing.

Responsabilidades

• Implement care management review processes per established criteria and guidelines.
• Ensure compliance with state, federal laws and regulatory requirements.
• Conduct care management reviews according to medical policies.
• Promote quality and efficiency in care management delivery.
• Respect privacy and share information only as permitted by law.
• Operate within ethical principles of nursing and care management.
• Identify patients who may benefit from Health Coaching or case management.
• Collaborate with providers and vendors to streamline processes.
• Develop and maintain positive relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Perform other duties as assigned.

Conhecimentos

RN Case Management

Health Coaching

Regulatory compliance

Data analysis

Communication skills

Team collaboration

Formação académica

Bachelor’s Degree in Nursing

Descrição da oferta de emprego

Highmark Inc. is seeking a full-time remote RN case manager with weekend availability (Sat/Sun) and three weekdays. Responsibilities include reviewing care appropriateness, applying criteria for resource use, and coordinating with Health Coaches and case management to improve provider and member outcomes.

The role emphasizes privacy, ethical practice, and proactive analysis to enhance service quality. Requires active RN licensure and 3 years of relevant clinical experience.