Remote RN Care Manager - Weekend Coverage & Impact

Highmark Health; Utah; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time remote RN care manager with weekend availability (Saturday and Sunday) and three weekdays. The role focuses on utilization management, reviewing care appropriateness, applying criteria, and identifying opportunities for health coaching and case management.

You will educate providers and members, monitor outcomes, and develop action plans to improve care quality. Requirements include RN licensure, 3 years of clinical experience, and a Bachelor’s degree in

Qualifications

• 3 years of related, progressive clinical experience in care management or UM/CM/QA
• Experience in a clinical setting
• RN licensure in PA or multi-state via eNLC; state-specific may be required

Responsibilities

• Implement care management reviews following criteria and policies
• Ensure compliance with state and federal laws
• Refer members to Health Coaching/case management
• Educate providers and facilities to improve processes
• Develop relationships with internal and external customers
• Use outcomes data to improve services
• Other duties as needed

Skills

Regulatory guidelines knowledge

Multitasking

Communication skills

Data analysis

Team player

Analytical skills

Organizational skills

Deadline management

Education

Bachelor's Degree in Nursing

Job description

Highmark Inc. is seeking a full-time remote RN care manager with weekend availability (Saturday and Sunday) and three weekdays. The role focuses on utilization management, reviewing care appropriateness, applying criteria, and identifying opportunities for health coaching and case management.

You will educate providers and members, monitor outcomes, and develop action plans to improve care quality. Requirements include RN licensure, 3 years of clinical experience, and a Bachelor’s degree in