Remote RN Care Manager | Weekend Availability

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

Job summary

Highmark Inc. is seeking a qualified Care Manager for a full-time remote position requiring weekend availability (Saturday and Sunday) and three weekdays.

You will implement utilization management strategies, review care appropriateness, and refer to Health Coaching or case management as needed. The role emphasizes collaboration with providers, adherence to regulatory standards, and data-driven improvements to member outcomes.

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• RN licensure in PA or multi-state licensure via eNLC; additional state licensure may be required.

Responsibilities

• Implement care management review processes aligned with standards and guidelines.
• Promote quality and efficiency in care management services.
• Identify and refer members to Health Coaching/case management interventions.
• Educate providers and vendors to streamline processes and build relationships.
• Develop positive working relationships with internal and external customers.
• Use outcomes data to improve ongoing care management services.
• Other duties as assigned.

Skills

Regulatory & compliance

Multitasking

Communication skills

Data analysis

Team player

Organizational skills

Prioritization

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a qualified Care Manager for a full-time remote position requiring weekend availability (Saturday and Sunday) and three weekdays.

You will implement utilization management strategies, review care appropriateness, and refer to Health Coaching or case management as needed. The role emphasizes collaboration with providers, adherence to regulatory standards, and data-driven improvements to member outcomes.