Unknown Company is hiring a Transplant Care Nurse (Remote)

Highmark Inc. is looking for a Transplant Care Nurse to implement effective utilization and case management strategies for an assigned member panel. You'll provide oversight, assess health management needs using data and clinical judgment, and conduct outreach to coordinate care.

What You'll Do

• Maintain oversight over a specified panel of members by performing ongoing assessment of their health management needs.
• Identify appropriate clinical interventions and triage members to appropriate resources.
• Implement care management review processes consistent with industry, corporate, state, and federal law standards.
• Create care plans to address members’ identified needs, remove barriers to care, identify resources, and help improve health outcomes.
• Ensure all activities are documented and conducted in compliance with applicable business process, regulatory, and accreditation standards.

What We're Looking For

• A High School diploma or GED.
• 7 years in any combination of clinical, case/utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience.
• 1 year of experience in a clinical setting.
• A current RN license in PA, WV, DE, or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment.

Nice to Have

• A Bachelor's Degree in Nursing.
• 5 years of experience in UM/CM/QA/Managed Care.
• 1 year of advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT).
• 1 year working with the healthcare needs of a diverse population and understanding the importance of cultural competency.
• Certification in utilization management or a related field.
• Certification in Case Management.

Compensation

• The salary range for this position is $57,700.00 - $107,800.00.

Work Mode

This is a fully remote position.

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 any category protected by applicable federal, state, or local law.