Remote RN Care Manager — Weekend Availability

Highmark Health; Sioux Falls (SD); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote RN Case Manager to support utilization management and care coordination. The role requires weekend availability (Saturday and Sunday) in addition to three weekdays, and involves reviewing care appropriateness, applying criteria, and coordinating with Health Coaches and case managers.

The position emphasizes education of providers and members, data analysis to improve outcomes, and collaboration with internal and external teams.

Qualifications

• Registered nurse (RN) licensure and, if applicable, multi-state licensure (eNLC) or state licensure requirements.
• Minimum 3 years of related clinical experience in care management or a similar field.
• Experience in Utilization Management, Case Management, QA or Managed Care.
• Experience with acute inpatient and post-acute settings is preferred.

Responsibilities

• Implement care management reviews consistent with standards and guidelines.
• Adhere to applicable state and federal laws and regulatory compliance.
• Apply established criteria and guidelines to care management reviews.
• Promote quality and efficiency in care management services.
• Respect patient privacy and protect information within legal bounds.
• Refer members to Health Coaching/case management when appropriate.

Skills

Communication skills

Advanced computer & software skills

Multitasking ability

Team player with analytical skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a remote RN Case Manager to support utilization management and care coordination. The role requires weekend availability (Saturday and Sunday) in addition to three weekdays, and involves reviewing care appropriateness, applying criteria, and coordinating with Health Coaches and case managers.

The position emphasizes education of providers and members, data analysis to improve outcomes, and collaboration with internal and external teams.