Care Manager Rn - Utilization Management (um) Remote

Highmark Health

Base: $68,400.00 - $105,900.00; bonus/equity: not ...
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3 years clinical experience
Current pa rn licensure
Review of healthcare services appropriateness
** Highmark Health is seeking a Care Manager RN specializing in Utilization Management for a remote position. The role involves implementing care management strategies, analyzing healthcare service delivery, and promoting efficiency and quality in care while ensuring compliance with regulations. **

Job Summary

  • This role implements effective utilization management strategies including the review of appropriateness of health care services and application of criteria to ensure appropriate resource utilization.
  • The position requires identifying opportunities for referral to Health Coaching and resolving quality issues while educating providers and members on a proactive basis.
  • Candidates must hold a current state of Pennsylvania RN license or multi-state licensure through the enhanced Nurse Licensure Compact.

Matching Summary

Match Score: 75

** Highmark Health is seeking a Care Manager RN specializing in Utilization Management for a remote position. The role involves implementing care management strategies, analyzing healthcare service delivery, and promoting efficiency and quality in care while ensuring compliance with regulations. **

Salary

Base: $68,400.00 - $105,900.00; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • 3 years clinical experience
  • Current PA RN licensure
  • Review of healthcare services appropriateness
  • Application of medical criteria
  • Data analysis for quality improvement

Nice-to-have

  • Experience in UM/CM/QA/Managed Care
  • Certification in utilization management
  • Strong analytical and organizational skills
  • Ability to work in fast-paced environment
  • Innovative and flexible team player

Key Requirements

  • Bachelor's Degree in Nursing preferred
  • 3 years related progressive clinical experience
  • Current State of PA RN licensure
  • Multi-state licensure via eNLC accepted
  • Certification in utilization management preferred

Work Rights

Not specified

Tailored Resume

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