Remote RN Care Manager — Weekend Availability & Care Coordination

Highmark Health; Elm (PA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Care Management professional, requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

The role focuses on using established criteria to review care, drive quality, and coordinate with Health Coaches and care teams to improve member outcomes. Responsibilities include applying guidelines, educating providers, maintaining privacy, and promoting efficient care management.

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• 3 years RN experience and RN Case Management/Care Management.
• Experience with UM/CM/QA/Managed Care and in inpatient/outpatient settings.

Responsibilities

• Implement care management review processes consistent with standards and policies.
• Function in accordance with applicable laws and regulatory compliance.
• Implement reviews per established criteria and medical policies.
• Promote quality and efficiency in care management services.
• Respect member privacy and share only relevant information.
• Identify and refer members to Health Coaching/case management interventions.
• Employ collaborative interventions to maximize health outcomes.
• Educate providers and vendors to streamline processes and build relationships.
• Develop and sustain positive relationships with internal and external customers.
• Utilize outcomes data to improve care management services.
• Other duties as assigned or requested.

Skills

Regulatory knowledge

Multi tasking

Communication skills

Data analysis

Team player

Prioritization

Computer skills

Analytical skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Care Management professional, requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

The role focuses on using established criteria to review care, drive quality, and coordinate with Health Coaches and care teams to improve member outcomes. Responsibilities include applying guidelines, educating providers, maintaining privacy, and promoting efficient care management.