Care Manager, RN

Highmark Health

Care Manager RN implementing effective utilization management strategies for Highmark Health. Responsibilities include reviewing health care services and improving provider performance and member satisfaction remotely.

Posted 6/5/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $68,400 - $105,900 per yearWebsite

About the role

Key responsibilities & impact

Implement care management review processes that are consistent with established industry and corporate standards
Function in accordance with applicable state, federal laws and regulatory compliance
Promote quality and efficiency in the delivery of care management services
Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions

Requirements

What you’ll need

3 years of related, progressive clinical experience in the area of specialization
Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
Certification in utilization management or a related field (preferred)
Working knowledge of pertinent regulatory and compliance guidelines and medical policies
Ability to analyze data, measure outcomes, and develop action plans

Benefits

Comp & perks

Health insurance
Retirement plans
Paid time off
Flexible work arrangements

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical experiencedata analysisoutcome measurementaction plan development

Soft Skills

quality promotionefficiency promotion

Certifications

RN licensuremulti-state licensureutilization management certification