Remote RN Care Manager - Weekend & Weekday Coverage

Highmark Health; Yorktown (VA); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Inc. is seeking a full-time RN Case Manager for a remote position requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

The role focuses on utilization management, review of care services, applying criteria to ensure appropriate resource use, and coordinating with Health Coaching and case management to improve provider and member outcomes. Responsibilities include implementing care management reviews, ensuring regulatory compliance, educating providers,

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.

Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards.
• Function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted and established criteria and medical policies.
• Promote quality and efficiency in the delivery of care management services.
• Respect the member’s right to privacy within legal boundaries.
• Identify and refer members who may benefit from Health Coaching/case management interventions.
• Employ collaborative interventions to maximize health care outcomes and build network relationships.
• Educate providers and vendors to streamline processes and improve performance.
• Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve ongoing care management services.
• Other duties as assigned or requested

Education

Bachelor's Degree in Nursing

Tools

MS Office

Job description

Highmark Inc. is seeking a full-time RN Case Manager for a remote position requiring weekend availability (Saturday and Sunday) in addition to three weekdays.

The role focuses on utilization management, review of care services, applying criteria to ensure appropriate resource use, and coordinating with Health Coaching and case management to improve provider and member outcomes. Responsibilities include implementing care management reviews, ensuring regulatory compliance, educating providers,