Remote RN Care Manager: Weekend Specialist

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

Job summary

Highmark Health is seeking a registered nurse for a remote care management role requiring weekend availability and three weekdays. You will review care across settings, apply utilization criteria, and identify opportunities for referral to Health Coaching and case management.

You will monitor quality metrics, educate providers and members, and respond to inquiries with proactive care alternatives. The role emphasizes adherence to privacy laws, collaboration with internal/external teams, and use

Qualifications

• RN with active state licensure or multi-state license where applicable
• 3+ years of clinical experience in care management or a related field
• Experience in utilization management or managed care settings (UM/CM/QA) preferred
• Strong written and verbal communication, with ability to educate providers and members

Responsibilities

• Implement care management reviews aligned with industry standards and medical policies
• Ensure compliance with state and federal laws
• Identify and refer members to Health Coaching or case management when appropriate
• Educate providers/vendors and build strong network relationships
• Utilize outcomes data to improve care management services

Skills

Regulatory compliance

Data analysis

Communication skills

Multitasking

Team player

Analytical skills

Education

Bachelor's Degree in Nursing

Tools

EHR systems

Job description

Highmark Health is seeking a registered nurse for a remote care management role requiring weekend availability and three weekdays. You will review care across settings, apply utilization criteria, and identify opportunities for referral to Health Coaching and case management.

You will monitor quality metrics, educate providers and members, and respond to inquiries with proactive care alternatives. The role emphasizes adherence to privacy laws, collaboration with internal/external teams, and use