Remote RN Care Manager: Weekend Availability

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

Job summary

Highmark Health is hiring for a full-time remote care management role with weekend availability (Sat/Sun) and three weekdays. You will implement utilization management strategies, review care appropriateness, and coordinate interventions to improve provider and member satisfaction.

Required: ~3 years clinical experience, RN license (PA or multistate via eNLC), and strong communication. Preference for Utilization Management certification. Strong data analytics and regulatory knowledge are valued.

Qualifications

• Requires ~3 years of related clinical experience.
• RN licensure in PA or multi-state licensure via eNLC.
• Certification in Utilization Management preferred.

Responsibilities

• Implement care management review processes that align with industry and corporate standards.
• Ensure compliance with state and federal laws and regulatory requirements.
• Conduct care management reviews according to established criteria and medical policies.
• Promote quality and efficiency in care management services.
• Respect privacy and share information only as permitted by law.
• Identify and refer members who could benefit from Health Coaching/case management interventions.
• Educate providers and vendors to streamline processes and build network rapport.
• Develop and sustain positive relationships with internal and external customers.
• Use outcomes data to improve care management services.

Skills

Regulatory guidance

Multitasking

Communication skills

Data analysis

Team player

Time management

Computer literacy

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is hiring for a full-time remote care management role with weekend availability (Sat/Sun) and three weekdays. You will implement utilization management strategies, review care appropriateness, and coordinate interventions to improve provider and member satisfaction.

Required: ~3 years clinical experience, RN license (PA or multistate via eNLC), and strong communication. Preference for Utilization Management certification. Strong data analytics and regulatory knowledge are valued.