Remote RN Care Manager - Weekend Care Coordination

Highmark Health; Madison (WI); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote Care Management Specialist to implement utilization management strategies, review care decisions, and coordinate referrals to Health Coach/case management while maintaining privacy and regulatory compliance.

Weekend availability (Saturday and Sunday) plus three weekdays is required, with RN licensure and 3 years of clinical experience. A Bachelor's in Nursing is preferred.

Qualifications

• 3 years of related, progressive clinical experience in care management or a related field.
• Active RN licensure (state as indicated in job posting) and current CPR/ACLS if applicable.
• Bachelor’s degree in Nursing preferred.
• Experience with UM/CM/QA/Managed Care is preferred.

Responsibilities

• Implement care management review processes aligned with established standards and policies.
• Ensure compliance with state and federal regulations.
• Conduct care management reviews using established criteria and policies.
• Promote quality and efficiency in care management services.
• Protect member privacy and share only necessary information.

Skills

Care coordination

Regulatory compliance

Data analysis

Communication skills

Team collaboration

Privacy & confidentiality

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote Care Management Specialist to implement utilization management strategies, review care decisions, and coordinate referrals to Health Coach/case management while maintaining privacy and regulatory compliance.

Weekend availability (Saturday and Sunday) plus three weekdays is required, with RN licensure and 3 years of clinical experience. A Bachelor's in Nursing is preferred.