Remote RN Care Navigator – Care Coordination

Highmark Health; Pennsylvania; Hybrid; USD 73,000 - 117,000; Full time

Job summary

Highmark Health is seeking a RN Care Coordinator to manage care transitions and coordinate with the care team. This hybrid, full-time role requires travel within PA and working with members wherever they are located.

A BSN is required, with at least 2 years of RN experience in acute or care-management settings. The candidate will obtain necessary pre-certifications, drive utilization review, and support compliant care planning.

Qualifications

• Bachelor’s Degree in Nursing is required (or 6 years related experience in lieu of degree).
• 2 years of RN experience in acute care, home care, palliative, hospice, or care management is required.

Responsibilities

• Coordinate assessment of patient needs and transition of care.
• Develop and communicate continuum of care plans with care team and providers.
• Document, verify, and monitor data to evaluate interventions and outcomes; respond to readmissions.
• Obtain pre-certifications and authorizations from payers and arrange post-acute services as needed.
• Educate AHN staff on utilization review practices and payer guidelines.

Skills

Motivational interviewing

Advance care planning

Teamwork

Time management

Microsoft Office

Education

Bachelor's Degree in Nursing

6 years related experience in lieu of degree

Tools

Microsoft Office

Job description

Highmark Health is seeking a RN Care Coordinator to manage care transitions and coordinate with the care team. This hybrid, full-time role requires travel within PA and working with members wherever they are located.

A BSN is required, with at least 2 years of RN experience in acute or care-management settings. The candidate will obtain necessary pre-certifications, drive utilization review, and support compliant care planning.