Remote RN Care Manager – Weekend Coverage

Highmark Health; Hartford (CT); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time RN Care Manager for a remote role requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

This position implements utilization management strategies, reviews the appropriateness of health care services, and coordinates with Health Coaches to improve provider and member outcomes. Required are an RN license and 3 years of related clinical experience; a Bachelor’s Degree in Nursing is preferred.

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• Certification in Utilization Management or a related field

Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws.
• Practice within the scope of ethical principles.
• Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
• Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve ongoing care management services.
• Other duties as assigned or requested

Skills

Regulatory compliance

Data analysis

Communication skills

Team collaboration

Education

Bachelor’s Degree in Nursing

Job description

Highmark Inc. is seeking a full-time RN Care Manager for a remote role requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

This position implements utilization management strategies, reviews the appropriateness of health care services, and coordinates with Health Coaches to improve provider and member outcomes. Required are an RN license and 3 years of related clinical experience; a Bachelor’s Degree in Nursing is preferred.