Remote RN Care Manager - Weekend Availability

Highmark Health; Salem (NH); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time remote Utilization Management Nurse who will implement care management reviews, educate providers and members, and monitor health care service delivery. The role requires weekend availability (Saturday and Sunday) plus three weekdays, and compliance with privacy and regulatory standards.

The ideal candidate holds a nursing license, about 3 years of related clinical experience, and demonstrates strong data analysis, communication, and collaboration skills to

Qualifications

• 3 years of related clinical experience
• RN licensure active in any US state or compact
• Experience in UM/CM/QA/Managed Care preferred

Responsibilities

• Implement care management reviews per criteria and policies
• Ensure compliance with state/federal laws and regulations
• Promote quality and efficiency in care management services
• Identify and refer members to Health Coaching/case management
• Educate providers and vendors to streamline processes
• Develop relationships with internal and external customers
• Use outcomes data to improve care management services
• Respond to customer inquiries and provide interventions or alternatives

Skills

Care management

Healthcare compliance

Data analysis

Communication skills

HIPAA compliance

Team collaboration

Adaptability

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time remote Utilization Management Nurse who will implement care management reviews, educate providers and members, and monitor health care service delivery. The role requires weekend availability (Saturday and Sunday) plus three weekdays, and compliance with privacy and regulatory standards.

The ideal candidate holds a nursing license, about 3 years of related clinical experience, and demonstrates strong data analysis, communication, and collaboration skills to