Case Manager RN - Remote

IntelliResume; Pennsylvania; Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Health is seeking a Case Manager RN to deliver comprehensive case management services, coordinating care to ensure quality and cost-effective outcomes.

The role focuses on assessing needs, developing individualized plans, coordinating services, and advocating for members’ health care needs in a compliant, efficient manner.

Qualifications

• High School Diploma or GED required.
• Bachelor’s Degree in Nursing preferred.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Coordinate referrals to specialists and community resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet a member's individual health care needs.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements.
• Identify areas for potential cost savings, quality improvement, and workflow efficiencies.

Education

High School Diploma/GED

Bachelor’s Degree in Nursing

Job description

About This Role

The Case Manager RN is responsible for providing comprehensive case management services to members, ensuring quality and cost-effective care delivery while promoting optimal health outcomes. This role is ideal for experienced nurses who excel in assessing needs, developing care plans, and coordinating services.

Highlights

• Pay: $72,700 - $116,600/year
• Location: Pa, US
• Schedule: Full-time

What You'll Do

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Coordinate referrals to specialists and community resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet a member's individual health care needs.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements.
• Identify areas for potential cost savings, quality improvement, and workflow efficiencies.

Requirements

Education:

• High School Diploma/GED required
• Bachelor’s Degree in Nursing preferred

Experience:

• 3 years in clinical, case/utilization management, and/or disease condition management experience required
• Experience working with diverse populations preferred

Licenses & Certifications:

• Current State of PA RN licensure or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) required

About Highmark Health

Highmark Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on quality, cost-effective solutions to improve health outcomes for their members.