Remote RN Care Manager - Weekends & UM Expert

Highmark Health; Yuma (AZ); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Care Management professional to implement utilization management strategies and support member outcomes. The role requires weekend availability and three weekdays, with responsibilities spanning review of care, adherence to policies, and collaborating with providers, members, and Health Coaches.

The position emphasizes privacy, ethical practice, and data-driven improvements in care quality, outcomes, and efficiency, with opportunities to educate facilities and

Qualifications

• Current PA RN licensure or active multi-state licensure via eNLC is required.
• Certification in Utilization Management is preferred.

Responsibilities

• Implement care management reviews per established criteria and policies.
• Ensure compliance with state and federal laws.
• Conduct care management reviews and apply approved guidelines.
• Promote quality and efficiency in care management services.
• Protect member privacy and only share information relevant to care.
• Educate providers and vendors to improve processes and network relationships.
• Develop relationships with internal/external customers and use outcomes data to drive improvements.
• Identify and refer patients to Health Coaching/case management when beneficial.

Skills

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Team player

Prioritization

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Health is seeking a remote Care Management professional to implement utilization management strategies and support member outcomes. The role requires weekend availability and three weekdays, with responsibilities spanning review of care, adherence to policies, and collaborating with providers, members, and Health Coaches.

The position emphasizes privacy, ethical practice, and data-driven improvements in care quality, outcomes, and efficiency, with opportunities to educate facilities and