Remote RN Care Manager with Weekend Availability

Highmark Health; Heber (UT); Remote; USD 68,000 - 106,000; Full time

Job summary

Highmark Health (Highmark Inc.) is seeking a remote Care Manager to implement utilization management strategies, review care appropriateness, and identify opportunities for Health Coach interventions. The role requires weekend availability (Saturday and Sunday) and three weekdays, with responsibilities spanning provider education, data analysis, and process improvement.

The position emphasizes regulatory compliance, patient privacy, and collaboration with internal and external stakeholders to

Qualifications

• Current PA RN license or multi-state licensure via eNLC; additional state licensure may be required.
• 3 years of related, progressive clinical experience in the area of specialization.
• RN Case Management, Care Management, UM/CM/QA/Managed Care experience preferred.
• Experience with acute inpatient and post-acute care settings.

Responsibilities

• Implement care management review processes per established standards and guidelines.
• Comply with applicable state and federal laws and regulatory requirements.
• Perform care management reviews according to criteria and policies.
• Promote quality and efficiency in care management services.
• Respect member privacy and share only necessary information.
• Practice ethical principles.
• Identify and refer members who could benefit from Health Coaching/case management.
• Collaborate to maximize member health outcomes and develop network relationships.
• Educate providers and vendors to streamline processes and build rapport.
• Develop positive relationships with internal and external customers.
• Use outcomes data to improve care management services.
• Other duties as assigned.

Skills

Regulatory knowledge

Multitasking

Communication skills

Data analysis

Team player

Prioritization

Computer skills

Education

Bachelor's Degree in Nursing

Job description

Highmark Health (Highmark Inc.) is seeking a remote Care Manager to implement utilization management strategies, review care appropriateness, and identify opportunities for Health Coach interventions. The role requires weekend availability (Saturday and Sunday) and three weekdays, with responsibilities spanning provider education, data analysis, and process improvement.

The position emphasizes regulatory compliance, patient privacy, and collaboration with internal and external stakeholders to