Remote RN Care Manager — Weekend Coverage

Highmark Health; Columbus (OH); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time RN for a remote role with weekend availability (Sat/Sun) and three weekdays. You will implement care management reviews, apply criteria for appropriate services, identify referrals to Health Coach/case management, and monitor steps to improve provider and member satisfaction.

You will educate providers and facilities, analyze outcomes data, and collaborate to optimize care processes while upholding privacy laws and regulatory requirements.

Qualifications

• Active RN license in PA or multi-state (eNLC)
• 3 years of related, progressive clinical experience in the area of specialization
• Experience in UM/CM/QA/Managed Care
• Experience with acute inpatient and post-acute care

Responsibilities

• Implement care management review processes consistent with established standards and the care manager’s discipline.
• Function in accordance with applicable state and federal laws and regulatory compliance.
• Implement care management reviews according to criteria and medical policies.
• Promote quality and efficiency in care management services.
• Respect the member’s privacy and share only information relevant to care within legal frameworks.
• Practice within the scope of ethical principles.
• Identify and refer members who could benefit from Health Coaching/case management interventions.
• Employ collaborative interventions to optimize member health care outcomes and develop provider resources.
• Educate professional and facility providers to streamline processes and improve network relations.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve care management services.
• Other duties as assigned.

Skills

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Enthusiastic/flexible

Team player

Prioritization

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a full-time RN for a remote role with weekend availability (Sat/Sun) and three weekdays. You will implement care management reviews, apply criteria for appropriate services, identify referrals to Health Coach/case management, and monitor steps to improve provider and member satisfaction.

You will educate providers and facilities, analyze outcomes data, and collaborate to optimize care processes while upholding privacy laws and regulatory requirements.