Remote RN Care Manager – Weekend Availability

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

Job summary

Highmark Health in the United States offers a full-time REMOTE care management role requiring weekend availability. The position focuses on utilization management, reviewing services, applying criteria, and guiding members toward Health Coaching and case management to improve provider and member satisfaction.

The role involves educating providers, analyzing data, and developing strategies to enhance care quality, while maintaining privacy and compliance with laws.

Qualifications

• RN with ~3 years of clinical experience.
• Current PA RN license or multi-state license via eNLC.
• Bachelor’s Degree in Nursing preferred.
• Experience in UM/CM/QA/Managed Care is preferred.
• Knowledge of regulatory compliance requirements.

Responsibilities

• Implement care management review processes per standards and policies.
• Ensure compliance with applicable laws.
• Execute care management reviews using established criteria and guidelines.
• Promote quality and efficiency in care management services.
• Identify and refer members to Health Coaching or case management.
• Educate providers and vendors to streamline processes and build relationships.
• Use outcomes data to improve services.
• Collaborate with internal and external customers.

Skills

Regulatory compliance

Data analysis

Excellent communication

Team collaboration

Multitasking

Problem solving

Education

Bachelor's Degree in Nursing

Job description

Highmark Health in the United States offers a full-time REMOTE care management role requiring weekend availability. The position focuses on utilization management, reviewing services, applying criteria, and guiding members toward Health Coaching and case management to improve provider and member satisfaction.

The role involves educating providers, analyzing data, and developing strategies to enhance care quality, while maintaining privacy and compliance with laws.