Remote RN Care Manager – Weekends/Weekdays

Highmark Health; Lake Michigan Beach (MI); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a RN for a remote care management role requiring weekend availability (Saturday and Sunday) in addition to three weekdays. You will implement care management review processes, promote quality and efficiency, and educate providers and members to improve outcomes while ensuring privacy and regulatory compliance.

Required RN licensure (PA or eNLC), 3+ years of clinical experience, and knowledge of UM/CM/QA/Managed Care; Bachelor's in Nursing preferred.

Qualifications

• Bachelor's degree in nursing or related field preferred
• 3 years of related, progressive clinical experience in the area of specialization
• Experience in a clinical setting

Responsibilities

• Implement care management review processes consistent with industry and corporate standards
• Function in accordance with applicable laws and regulatory compliance
• Implement care management reviews according to approved guidelines and medical policies
• Promote quality and efficiency in care management services
• Respect member privacy and share only information relevant to care
• Educate providers and vendors to streamline processes and develop relationships
• Identify and refer members who may benefit from Health Coaching/case management interventions
• Develop and sustain positive working relationships with internal and external customers
• Utilize outcomes data to improve care management services
• Other duties as assigned or requested

Education

Bachelor's Degree in Nursing

Job description

Highmark Health is seeking a RN for a remote care management role requiring weekend availability (Saturday and Sunday) in addition to three weekdays. You will implement care management review processes, promote quality and efficiency, and educate providers and members to improve outcomes while ensuring privacy and regulatory compliance.

Required RN licensure (PA or eNLC), 3+ years of clinical experience, and knowledge of UM/CM/QA/Managed Care; Bachelor's in Nursing preferred.