Remote RN Care Manager: Weekends & Weekdays

Highmark Health; West Virginia; Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a remote Care Management Specialist to implement utilization review processes and support member care during weekends and three weekdays. You will work to ensure appropriate care, promote quality, and identify opportunities for referral to coaching or case management.

The role requires RN licensure in PA or multi-state licensure via eNLC, a nursing degree, and 3 years of clinical experience. Strong data skills and collaboration with providers are expected.

Qualifications

• Regulatory knowledge and compliance understanding.
• Ability to multi-task in a fast paced care setting.
• Strong written and verbal communication skills.
• Ability to analyze data, measure outcomes, and develop action plans.

Responsibilities

• Implement care management review processes per established criteria and policies.
• Ensure compliance with state and federal laws.
• Promote quality and efficiency in care management services.
• Educate providers and members and respond to inquiries with suitable interventions.
• Identify and refer members to Health Coaching or case management when needed.
• Develop relationships with internal and external stakeholders.
• Use outcomes data to improve services.

Skills

Regulatory guidelines

Multi-tasking

Communication skills

Data analysis

Team collaboration

Prioritization

Attention to detail

Organization

Education

Bachelor’s degree in Nursing

Job description

Highmark Health is seeking a remote Care Management Specialist to implement utilization review processes and support member care during weekends and three weekdays. You will work to ensure appropriate care, promote quality, and identify opportunities for referral to coaching or case management.

The role requires RN licensure in PA or multi-state licensure via eNLC, a nursing degree, and 3 years of clinical experience. Strong data skills and collaboration with providers are expected.