Remote RN Care Manager – Weekend & Utilization Mgmt

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

Job summary

Highmark Health is seeking a full-time RN for a remote role that requires weekend availability (Saturday and Sunday) in addition to three weekdays. The role focuses on utilization management, reviewing care plans, applying criteria, and identifying opportunities for Health Coaching and case management.

Responsibilities include implementing care management reviews, complying with laws, educating providers, and analyzing outcomes to improve patient care.

Qualifications

• RN licensure required or multi-state compact where applicable.
• Experience in utilization management or case management preferred.
• Experience in clinical settings with health care workflows.

Responsibilities

• Implement care management reviews per industry standards and policy.
• Ensure compliance with state and federal laws in care management.
• Refer members to Health Coaching/case management when appropriate.
• Educate providers and vendors to improve care processes and outcomes.
• Protect member privacy and data in accordance with laws.

Skills

Regulatory knowledge

Compliance awareness

Data analysis

Multitasking

Communication skills

Team player

Time management

Education

Bachelor's Degree in Nursing

Tools

EHR Systems

Job description

Highmark Health is seeking a full-time RN for a remote role that requires weekend availability (Saturday and Sunday) in addition to three weekdays. The role focuses on utilization management, reviewing care plans, applying criteria, and identifying opportunities for Health Coaching and case management.

Responsibilities include implementing care management reviews, complying with laws, educating providers, and analyzing outcomes to improve patient care.