Care Manager, RN

Highmark Health

. Implement care management review processes consistent with industry and corporate standards and the care manager’s professional discipline .

Posted 11/11/2026full-timePennsylvania • United StatesMid-LevelSenior💰 $68,400 - $105,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care management processes, regulatory compliance, and healthcare service delivery. Strong ability to analyze data, improve outcomes, and foster positive relationships with stakeholders.

Highest-signal resume keywords

Current RN Licensure3 Years Clinical ExperienceRegulatory Compliance KnowledgeData Analysis SkillsUtilization Management Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care Management Review ProcessesMedical Policy ApplicationHealthcare Service Delivery MonitoringQuality Issue ResolutionOutcome MeasurementAction Plan Development

Soft Skills

Excellent Communication SkillsOrganizational SkillsAbility to MultitaskInnovative ApproachCustomer Relationship Management

Tools & Technologies

Healthcare Software KnowledgeData Analysis Tools

Certifications & Qualifications

Utilization Management CertificationNursing Degree

Industry Keywords

Managed CareClinical SettingQuality AssuranceHealth CoachingCompliance Guidelines

About the role

Key responsibilities & impact

Implement care management review processes consistent with industry and corporate standards and the care manager’s professional discipline
Apply criteria, guidelines, and medical policies to conduct care management reviews
Monitor and analyze healthcare service delivery and utilization
Identify members who may benefit from Health Coaching or case management and make referrals
Educate providers, members, professional and facility providers, and vendors
Identify and resolve quality issues and develop strategies to improve provider and member satisfaction
Use collaborative interventions to maximize members’ healthcare outcomes
Develop and sustain positive relationships with internal and external customers
Use outcomes data to improve ongoing care management services
Respond to customer inquiries and offer interventions or alternatives
Comply with applicable laws, regulations, ethical principles, privacy requirements, and company policies
Perform other duties as assigned or requested

Requirements

What you’ll need

Current State of PA RN licensure OR current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
3 years of related, progressive clinical experience in the area of specialization
Experience in a clinical setting
Working knowledge of pertinent regulatory and compliance guidelines and medical policies
Ability to multitask 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
Enthusiastic, innovative, and flexible approach
Strong analytical and organizational skills
Demonstrated ability to prioritize work demands and meet deadlines
Excellent computer and software knowledge and skills
Physical work site required
Bachelor’s Degree in Nursing preferred
Experience in UM/CM/QA/Managed Care preferred
Certification in utilization management or a related field preferred

Benefits

Comp & perks

Remote work designation
Travel requirement of 0%–25%