Remote RN Care Manager with Weekend Availability

Highmark Health; Bismarck (ND); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a Clinical Care Manager for a remote role requiring weekend availability and three weekday shifts. The role focuses on utilization management, review of care appropriateness, and referral to health coaching or case management to enhance member outcomes.

Responsibilities include applying established criteria, educating providers, and analyzing data to drive service quality while maintaining patient privacy and regulatory compliance.

Qualifications

• 3 years of related, progressive clinical experience in the area of specialization.
• Experience in a clinical setting.
• RN Case Management or Care Management experience preferred.

Responsibilities

• Implement care management review processes according to established criteria and policies.
• Ensure compliance with state and federal laws and regulations.
• Refer members to Health Coaching or case management as appropriate.
• Educate providers and vendors to improve processes and network relationships.
• Use outcomes data to improve care management services.
• Assist with privacy protection and ethical practice in care delivery.

Skills

Regulatory knowledge

Data analysis

Communication skills

Privacy compliance

Team collaboration

Education

Bachelor’s Degree in Nursing

Job description

Highmark Health is seeking a Clinical Care Manager for a remote role requiring weekend availability and three weekday shifts. The role focuses on utilization management, review of care appropriateness, and referral to health coaching or case management to enhance member outcomes.

Responsibilities include applying established criteria, educating providers, and analyzing data to drive service quality while maintaining patient privacy and regulatory compliance.