Remote RN Care Manager — Weekend Availability

Highmark Health; North Dakota; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote RN with utilization management expertise to oversee care management reviews and ensure compliant, high-quality patient care. Weekend availability on Saturdays and Sundays plus three weekdays is required.

Ideal candidates will have RN licensure (PA or eNLC), 3+ years of clinical experience, and familiarity with health coaching and case management concepts. The role involves coordinating with providers, patients, and internal teams to optimize outcomes.

Qualifications

• Requires RN licensure in PA or eNLC with multi-state eligibility
• Experience in care management or UM/CM/QA is preferred
• RN experience in clinical settings is desirable

Responsibilities

• Implement care management reviews per established standards and policies
• Ensure compliance with state and federal laws and regulations
• Apply criteria to established guidelines and medical policies
• Promote quality and efficiency in care management delivery
• Protect member privacy and adhere to applicable laws
• Refer members to Health Coaching/case management when beneficial
• Educate providers and vendors to streamline processes and build relationships
• Develop positive working relationships with internal and external customers
• Utilize outcomes data to improve care management services
• Handle other duties as assigned

Skills

Regulatory knowledge

Multi-tasking

Communication skills

Data analysis

Flexible team player

Prioritization

Computer literacy

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote RN with utilization management expertise to oversee care management reviews and ensure compliant, high-quality patient care. Weekend availability on Saturdays and Sundays plus three weekdays is required.

Ideal candidates will have RN licensure (PA or eNLC), 3+ years of clinical experience, and familiarity with health coaching and case management concepts. The role involves coordinating with providers, patients, and internal teams to optimize outcomes.