Remote RN Care Manager - Weekend Coverage

Highmark Health; Salem (OR); A distancia; USD 68.000 - 106.000; Jornada completa

Descripción de la vacante

Highmark Health is seeking a full-time RN care management professional for a REMOTE position requiring weekend availability. You will apply utilization management strategies, review care appropriateness, and coordinate referrals to Health Coaches and case management to improve member outcomes.

You will educate providers and members, analyze data to identify quality improvements, and work within regulatory and privacy guidelines while collaborating with internal and external teams.

Formación

• 3 years of related, progressive clinical experience in care management.
• RN experience in a clinical setting.
• Experience in UM/CM/QA/Managed Care.

Responsabilidades

• Implement care management review processes in line with industry and corporate standards.
• Comply with state and federal laws and regulatory requirements.
• Apply criteria and guidelines for appropriate resource utilization.
• Promote quality and efficiency in care management services.
• Respect privacy and share only information relevant to care, under laws.
• Refer members to Health Coaching/case management as needed.
• Educate professionals and facilities to streamline processes and build network rapport.
• Develop positive relationships with internal and external customers.

Conocimientos

Regulatory knowledge

Multi-tasking

Communication skills

Data analysis

Team player

Time management

Educación

Bachelor’s Degree in Nursing

Herramientas

EMR systems

Descripción del empleo

Highmark Health is seeking a full-time RN care management professional for a REMOTE position requiring weekend availability. You will apply utilization management strategies, review care appropriateness, and coordinate referrals to Health Coaches and case management to improve member outcomes.

You will educate providers and members, analyze data to identify quality improvements, and work within regulatory and privacy guidelines while collaborating with internal and external teams.