330 Care Manager RN at Highmark Health Jobs in Columbia, SC
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Care Manager RN at Highmark Health
$71k-89k (estimate)
Full Time
2 Weeks Ago
Health eCareers is Hiring a Care Manager RN at Highmark Health Near Columbia, SC
CompanyHighmark Inc.
Job Description**JOB SUMMARY**
This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives.
**ESSENTIAL RESPONSIBILITIES**
Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager's professional discipline.
Function in accordance with applicable state, federal laws and regulatory compliance.
Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
Promote quality and efficiency in the delivery of care management services.
Respect the member's right to privacy, sharing only information relevant to the member's care and within the framework of applicable laws.
Practice within the scope of ethical principles.
Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
Employ collaborative interventions which focus, facilitate, and maximize the member's health care outcomes. Is familiar with the various care options and provider resources available to the member.
Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
Develop and sustain positive working relationships with internal and external customers.
Utilize outcomes data to improve ongoing care management services.
Other duties as assigned or requested
**EDUCATION**
**Required**
None
**Preferred**
Bachelor's Degree in Nursing
**EXPERIENCE**
**Required**
3 years of related, progressive clinical experience in the area of specialization
Experience in a clinical setting
**Preferred**
Experience in UM/CM/QA/Managed Care
**LICENSES AND CERTIFICATIONS**
**Required**
Current RN state licensure required. Additional specific state licensure(s) may be required depending on where clinical care is being provided.
**Preferred**
Certification in utilization management or a related field
**SKILLS**
Working knowledge of pertinent regulatory and compliance guidelines and medical policies
Ability to multi task and perform in a fast paced and often intense environment
Excellent written and verbal communication skills
Ability to analyze data, measure outcomes, and develop action plans
Be enthusiastic, innovative, and flexible
Be a team player who possesses strong analytical and organizational skills
Demonstrated ability to prioritize work demands and meet deadlines
Excellent computer and software knowledge and skills
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Remote
-Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.-
Pay Range Minimum$50,200.00
Pay Range Maximum$90,300.00
-Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.-
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( - )
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please contact HR Services Online at HRServices@
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J248109
Compensation Information$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
Job Description**JOB SUMMARY**
This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives.
**ESSENTIAL RESPONSIBILITIES**
Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager's professional discipline.
Function in accordance with applicable state, federal laws and regulatory compliance.
Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
Promote quality and efficiency in the delivery of care management services.
Respect the member's right to privacy, sharing only information relevant to the member's care and within the framework of applicable laws.
Practice within the scope of ethical principles.
Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
Employ collaborative interventions which focus, facilitate, and maximize the member's health care outcomes. Is familiar with the various care options and provider resources available to the member.
Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
Develop and sustain positive working relationships with internal and external customers.
Utilize outcomes data to improve ongoing care management services.
Other duties as assigned or requested
**EDUCATION**
**Required**
None
**Preferred**
Bachelor's Degree in Nursing
**EXPERIENCE**
**Required**
3 years of related, progressive clinical experience in the area of specialization
Experience in a clinical setting
**Preferred**
Experience in UM/CM/QA/Managed Care
**LICENSES AND CERTIFICATIONS**
**Required**
Current RN state licensure required. Additional specific state licensure(s) may be required depending on where clinical care is being provided.
**Preferred**
Certification in utilization management or a related field
**SKILLS**
Working knowledge of pertinent regulatory and compliance guidelines and medical policies
Ability to multi task and perform in a fast paced and often intense environment
Excellent written and verbal communication skills
Ability to analyze data, measure outcomes, and develop action plans
Be enthusiastic, innovative, and flexible
Be a team player who possesses strong analytical and organizational skills
Demonstrated ability to prioritize work demands and meet deadlines
Excellent computer and software knowledge and skills
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Remote
- Disclaimer:-** -The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.-
- Compliance Requirement:-** -This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.-
-Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.-
Pay Range Minimum$50,200.00
Pay Range Maximum$90,300.00
-Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.-
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( - )
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please contact HR Services Online at HRServices@
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J248109
Compensation Information$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
Job Summary
JOB TYPE
Full Time
SALARY
$71k-89k (estimate)
POST DATE
08/27/2024
EXPIRATION DATE
09/24/2024
WEBSITE
healthecareers.com
HEADQUARTERS
Denver, CO
SIZE
100 - 200
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