Oncology Case Manager RN: Coordinated Care & Advocacy

Highmark Health; Ohio; Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health in United States, Ohio seeks a Case Manager responsible for providing comprehensive case management services to members, ensuring quality, cost-effective care delivery and promoting optimal health outcomes. The role assesses needs, develops and implements care plans, coordinates services and monitors progress while containing costs.

You will collaborate with physicians and the health care team, document activities, guide lower-level Case Managers, and ensure compliance with HIPAA

Qualifications

• 5 years in clinical, case/utilization management, or health insurance experience.
• Experience with diverse populations.
• Advanced training in CBT, motivational interviewing, or DBT.
• Expertise in clinical assessment and care planning.
• Proficiency with Microsoft suite, case management software and EHRs.
• Strong understanding of healthcare systems and case management principles.
• Bachelors in Nursing.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and resources.
• Develop individualized care plans with members, physicians and other providers.
• Implement and coordinate care plans, ensuring access to services and resources.
• Monitor member progress and adjust care plans as needed.
• Advocate and liaison to meet individual health care needs per contract benefits.
• Collaborate with physicians and care teams to carry out the plan of care.
• Ensure activities are documented and compliant with policies and regulations.
• Provide guidance to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.

Education

Bachelors in Nursing

Tools

Microsoft Office

Electronic Health Records (EHR)

Case management software

Job description

Highmark Health in United States, Ohio seeks a Case Manager responsible for providing comprehensive case management services to members, ensuring quality, cost-effective care delivery and promoting optimal health outcomes. The role assesses needs, develops and implements care plans, coordinates services and monitors progress while containing costs.

You will collaborate with physicians and the health care team, document activities, guide lower-level Case Managers, and ensure compliance with HIPAA