Oncology Case Manager RN: Complex Care & Advocacy (Remote)

Highmark Health; Richmond (VA); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Health in Richmond, VA is seeking an experienced Case Manager to provide comprehensive management of members with complex health needs, coordinating services and facilitating quality, cost-effective care.

You will assess health status, develop individualized care plans with physicians and providers, monitor progress, advocate for members, mentor junior staff, and ensure complete documentation in line with policies and regulations.

Qualifications

• 5 years in clinical, case/utilization management, or health insurance experience.
• Experience with case management in healthcare settings.
• Preferred: specialty clinical experience (e.g., Oncology, Transplant, Maternity).
• Experience with diverse populations and cultural competency would be beneficial.
• CBT/DBT training is a bonus.

Responsibilities

• Manage caseload of members with complex health needs and advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members' health status, needs, and resources.
• Develop individualized care plans with physicians and providers.
• Coordinate and implement care plans to ensure access to services.
• Monitor progress and adjust plans as needed.
• Evaluate intervention effectiveness and services.
• Advocate for members and coordinate resources within contract benefits.
• Collaborate with physicians and healthcare team; document activities.
• Provide guidance to lower-level Case Managers.
• Other duties as assigned.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

EHR proficiency

MS Office

Care coordination

Healthcare systems

Education

High School/GED

Bachelor in Nursing

Tools

Case management software

Electronic health records

Job description

Highmark Health in Richmond, VA is seeking an experienced Case Manager to provide comprehensive management of members with complex health needs, coordinating services and facilitating quality, cost-effective care.

You will assess health status, develop individualized care plans with physicians and providers, monitor progress, advocate for members, mentor junior staff, and ensure complete documentation in line with policies and regulations.