Remote RN Care Manager: Weekend Availability & Outcomes

Highmark Health; Topeka (KS); Remote; USD 68,000 - 106,000; Full time

Job summary

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

This role focuses on utilization management, review of care appropriateness, and referrals to Health Coaching and case management to improve member outcomes. Responsibilities include applying established policies, educating providers and members, analyzing outcomes data, and promoting quality and efficiency in care delivery.

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• PA RN licensure required or multi-state licensure via eNLC.
• Certification in Utilization Management or a related field preferred.

Responsibilities

• Implement care management reviews following established standards and policies.
• Ensure compliance with applicable state/federal laws and regulatory requirements.
• Perform care management reviews according to approved criteria and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect patient privacy and share information only as legally allowed.
• Identify and refer members to Health Coaching/case management interventions.
• Educate providers and vendors to streamline processes and build network rapport.
• Develop positive relationships with internal and external customers.
• Utilize outcomes data to improve ongoing care management services.
• Other duties as assigned or requested.

Skills

Regulatory knowledge

Multi-tasking

Communication skills

Data analysis

Team player

Organizational skills

Advanced computer skills

Education

Bachelor’s Degree in Nursing

Job description

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

This role focuses on utilization management, review of care appropriateness, and referrals to Health Coaching and case management to improve member outcomes. Responsibilities include applying established policies, educating providers and members, analyzing outcomes data, and promoting quality and efficiency in care delivery.