Complex Case Manager RN - Remote

Highmark Health; Pennsylvania; Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare company is seeking a Complex Case Manager RN for a full-time remote role in Pennsylvania. The position involves managing member health needs, developing care plans, and coordinating care to achieve targeted patient outcomes. Applicants should have significant clinical experience and strong communication skills.

Qualifications

• 7 years of clinical, case management, or related experience required.
• Training in CBT, motivational interviewing, or DBT preferred.

Responsibilities

• Manage a panel of members with varying health statuses.
• Develop care plans and monitor outcomes.
• Coordinate care and address barriers.

Skills

Communication

Negotiation

Analytical

Organizational

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

MS Excel

Job description

Thank you for your interest in employment at a Highmark Health company. Highmark Health uses an online application process. If you participate in this process through the Workday site, your personal information, including resume, education, contact details, IP address, and other data you provide, will be collected and used according to our policies and applicable regulations, with your consent.

Complex Case Manager RN - Remote

Apply for the remote position based in Pennsylvania. This is a full-time role posted recently.

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This role involves managing a panel of members with varying health statuses. The incumbent assesses health needs, utilizes data and clinical judgment to determine interventions, and manages active cases. Responsibilities include developing care plans, encouraging behavior change, addressing barriers, coordinating care, and monitoring outcomes.

ESSENTIAL RESPONSIBILITIES

• Oversee members' health management needs and refer to appropriate resources.
• Create and implement care plans with goals and regular re-assessment contacts.
• Achieve targeted patient outcomes and document all activities in compliance with standards.
• Stay informed about regulatory and practice standards and adhere to them.
• Perform other duties as assigned.

EDUCATION

• Required: High School Diploma/GED
• Preferred: Bachelor's Degree in Nursing

EXPERIENCE

• Required: 7 years of clinical, case management, or related experience.
• Preferred: Training in CBT, motivational interviewing, or DBT; experience with diverse populations; understanding of cultural competency.

LICENSES AND CERTIFICATIONS

• Required: RN license in PA, WV, DE, or NY (others must be obtained within 6 months).
• Preferred: Certification in Case Management.

SKILLS

• Strong communication, negotiation, analytical, and organizational skills; ability to work independently and in teams; proficiency in MS Excel.

Additional Information

Position is office-based with occasional travel. Physical demands include lifting up to 25 pounds rarely. Compliance with HIPAA, privacy policies, and ethical standards is mandatory.

Salary range: $57,700 - $107,800, based on experience and location.

Highmark Health is committed to diversity and accessibility. For accommodations, contact [e-mail].