Complex Case Manager RN - Remote

Highmark Health; Pennsylvania; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization is seeking a dedicated case manager to oversee a panel of members with diverse health needs. The role involves assessing health management needs, developing care plans, and collaborating with a multidisciplinary team to ensure quality outcomes. The ideal candidate will have strong communication skills, a background in clinical case management, and a commitment to patient-centered care.

Qualifications

• 7 years of clinical, case management, or health insurance experience required.
• Preferred experience with cognitive behavioral therapy and cultural competency.

Responsibilities

• Oversee a panel of members and assess health needs.
• Create and implement care plans with short-term and long-term goals.
• Document all activities in compliance with standards.

Skills

Communication

Negotiation

Interpersonal Skills

Analytical Skills

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

MS Excel

Job description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This role involves ownership and oversight of a specific panel of members with varying health statuses and clinical needs. The incumbent assesses health management needs, uses data and clinical judgment to identify interventions, and collaborates with a multidisciplinary team to refer members to appropriate resources. Responsibilities include managing an active caseload, conducting outreach, developing care plans, encouraging behavior change, addressing barriers, coordinating care, and monitoring quality outcomes.

ESSENTIAL RESPONSIBILITIES

1. Oversee a panel of members by assessing health needs and identifying appropriate clinical interventions or referrals.
2. Create and implement care plans for members, setting both short-term and long-term goals, and conducting regular re-assessments.
3. Achieve targeted patient outcome goals, including care plan realization.
4. Document all activities in compliance with business, regulatory, and accreditation standards.
5. Maintain knowledge of and adhere to applicable regulations and standards for case management.
6. 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, disease management, provider operations, or health insurance experience.
• Preferred: Experience with cognitive behavioral therapy, motivational interviewing, or dialectical behavior therapy; working with diverse populations; understanding of cultural competency.

LICENSES AND CERTIFICATIONS

• Required: RN license in PA, WV, DE, or NY; other RN licenses must be obtained within 6 months.
• Preferred: Certification in Case Management.

SKILLS

• Strong written and verbal communication, negotiation, and interpersonal skills.
• Broad knowledge of disease processes and healthcare costs.
• Proficiency in MS Excel and analytical skills.
• Ability to work in a team, handle multiple priorities, and work autonomously.

OTHER INFORMATION

Position is office-based with travel of 0-25%. Physical demands include occasional lifting up to 50 pounds. The role involves teaching/training, travel, and working in a high-performing team environment.

Note: This job description provides a general overview and may not include all duties and responsibilities.