Remote RN Care Manager (Weekend Shifts)

Highmark Health; Guin (AL); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a Registered Nurse for a remote utilization management role requiring weekend availability (Saturday and Sunday) and three weekdays. You will review appropriateness of health care services, apply criteria for resource use, and identify opportunities for Health Coaching and care management interventions.

The position emphasizes educating providers/members, analyzing data, and improving provider performance and member satisfaction while maintaining privacy and compliance.

Qualifications

• Current PA RN licensure or multi-state licensure via eNLC is required.
• 3 years of related, progressive clinical experience in care management or UM/CM/QA/Managed Care.
• 3 years RN experience preferred; certification in Utilization Management or related field preferred.

Responsibilities

• Implement care management review processes aligned with industry standards and care manager discipline.
• Ensure compliance with state and federal laws and regulatory requirements.
• Perform care management reviews using established criteria and medical policies.
• Promote quality and efficiency in care management services.
• Identify and refer members who could benefit from Health Coaching/case management interventions.
• Educate providers and vendors to streamline processes and improve network relations.
• Develop relationships with internal and external customers and use outcomes data to improve services.

Skills

Regulatory compliance knowledge

Multitasking in fast-paced env

Excellent communication skills

Data analysis and action planning

Team player with organizational skills

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a Registered Nurse for a remote utilization management role requiring weekend availability (Saturday and Sunday) and three weekdays. You will review appropriateness of health care services, apply criteria for resource use, and identify opportunities for Health Coaching and care management interventions.

The position emphasizes educating providers/members, analyzing data, and improving provider performance and member satisfaction while maintaining privacy and compliance.