Care Manager RN – Utilization Management

Highmark Health

Care Manager RN at Highmark Health implementing effective utilization management strategies and improving provider performance. Requires clinical experience and nursing licensure in Pennsylvania.

Posted 6/24/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $68,400 - $105,900 per yearWebsite

About the role

Key responsibilities & impact

Implement effective utilization management strategies including review of appropriateness of health care services
Monitor and analyze the delivery of health care services
Educate providers and members on a proactive basis
Develop and sustain positive working relationships with internal and external customers

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.

Benefits

Comp & perks

Health insurance
Paid time off
Flexible work arrangements

ATS Keywords

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Applicant Tracking System Keywords

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Soft Skills

effective communicationrelationship buildingproactive educationmonitoringanalysis

Certifications

RN licensuremulti-state licensureutilization management certification