Remote RN Care Manager - Weekend-Available

Highmark Health

Augusta (ME)

Remote

USD 68,000 - 106,000

Full time

6 days ago

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Job summary

Highmark Inc. offers a full-time remote Care Manager RN role requiring weekend availability (Saturday and Sunday) plus three weekdays.

You will implement utilization management strategies, review care appropriateness, and coordinate referrals to Health Coaching and case management while monitoring provider and member outcomes. The position emphasizes HIPAA compliance, data-driven care improvement, and education of providers to enhance satisfaction and quality of care in a regulated healthcare

Qualifications

3 years of related, progressive clinical experience
Current PA RN licensure or multi-state licensure via eNLC with applicable state requirements
Bachelor’s Degree in Nursing preferred
Certification in Utilization Management preferred

Responsibilities

Implement care management reviews using established criteria and guidelines
Ensure compliance with applicable state, federal laws and regulatory standards
Refer members to Health Coaching/case management interventions when appropriate
Educate professional and facility providers to streamline processes and improve network rapport
Develop and sustain positive relationships with internal and external customers
Utilize outcomes data to improve ongoing care management services