Remote RN Care Manager - Weekend Coverage

Highmark Health; Eagle (ID); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a full-time remote Care Manager with a nursing background. The role involves utilization management, review of care services, and identification of opportunities for Health Coaching and case management, across weekend and weekday schedules.

The position emphasizes educating providers, improving member satisfaction, and applying data-driven strategies to enhance outcomes. Strong communication, regulatory compliance, and collaboration are essential.

Qualifications

• Bachelor’s degree in Nursing is preferred.
• ~3 years of related clinical experience in the area of specialization.
• Experience in UM/CM/QA/Managed Care.
• Experience in a clinical setting.

Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted guidelines and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect the member’s privacy and share only information relevant to care within legal limits.
• Practice within the scope of ethical principles.
• Identify and refer members who could benefit from Health Coaching/case management.
• Educate providers and vendors to streamline processes and build network rapport.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve care management services.

Skills

Care management

Healthcare experience

Data analysis

Regulatory compliance

Communication skills

HIPAA knowledge

Team collaboration

Education

Bachelor’s Degree in Nursing

RN licensure

Tools

EMR systems

Quality improvement tools

Job description

Highmark Health is seeking a full-time remote Care Manager with a nursing background. The role involves utilization management, review of care services, and identification of opportunities for Health Coaching and case management, across weekend and weekday schedules.

The position emphasizes educating providers, improving member satisfaction, and applying data-driven strategies to enhance outcomes. Strong communication, regulatory compliance, and collaboration are essential.