Remote RN Care Manager – Weekends & Weekdays

Highmark Health; Central City (KY); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Care Management position requiring weekend availability and three weekdays. You will implement care management reviews, ensure regulatory compliance, analyze outcomes, and identify opportunities for referrals to Health Coaching/case management to improve member satisfaction.

Required ~3 years clinical experience and an active RN license; Bachelor’s in Nursing preferred. This full-time role emphasizes collaboration with providers and adherence to HIPAA and

Qualifications

• RN with ~3 years clinical experience in the area of specialization.
• Experience in UM/CM/QA/Managed Care.
• Current PA RN license or multi-state licensure via eNLC.
• Certification in Utilization Management or related field preferred.
• Excellent written and verbal communication and analytical skills.

Responsibilities

• Implement care management review processes per established criteria and guidelines.
• Ensure compliance with state and federal laws and regulatory standards.
• Conduct care management reviews and apply medical policies.
• Promote quality and efficiency in care management services.
• Protect member privacy and share information only as required by law.
• Refer members to Health Coaching/case management when appropriate.
• Educate providers and vendors to streamline processes and build network relationships.
• Develop positive working relationships with internal and external customers.
• Utilize outcomes data to improve care management services.

Skills

Care management

Regulatory compliance

Data analysis

Communication skills

Multi-tasking

EMR systems

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a remote Care Management position requiring weekend availability and three weekdays. You will implement care management reviews, ensure regulatory compliance, analyze outcomes, and identify opportunities for referrals to Health Coaching/case management to improve member satisfaction.

Required ~3 years clinical experience and an active RN license; Bachelor’s in Nursing preferred. This full-time role emphasizes collaboration with providers and adherence to HIPAA and