Oncology Case Manager RN – Lead Care & Advocacy (Remote)

Highmark Health; Denver (CO); Hybride; USD 79 000 - 127 000; Plein temps

Résumé du poste

Highmark Health seeks an experienced Case Manager to deliver comprehensive case management services, assess member needs, and coordinate cost-effective, quality care. The role emphasizes planning, collaboration with physicians and care teams, and ongoing evaluation of interventions.

The candidate should hold an RN license (or multi-state eNLC) with 5+ years in case management or related areas and will pursue CCM certification within 36 months of hire.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management.
• Current RN licensure or multi-state eNLC.
• CCM certification must be obtained within 36 months of hire (exempt for incumbents as of Aug 2026).

Responsabilités

• Manage a caseload of members with complex health needs, requiring advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs and available resources.
• Develop individualized care plans with members, physicians and providers.
• Coordinate care plans and ensure access to services.
• Monitor progress and adjust care plans as needed.
• Evaluate interventions and services.
• Advocate and liaison to meet member health care needs using contract benefits.
• Collaborate with physicians, providers and health care team.
• Ensure activities are documented per policies and regulations.
• Provide guidance to lower-level Case Managers.
• Serve as clinical resource and problem-solver.

Connaissances

Clinical assessment & care planning

Leadership & mentoring

Negotiation & advocacy

Microsoft Office / EHR proficiency

Healthcare systems knowledge

Formation

High School/GED

Bachelors in Nursing

Description du poste

Highmark Health seeks an experienced Case Manager to deliver comprehensive case management services, assess member needs, and coordinate cost-effective, quality care. The role emphasizes planning, collaboration with physicians and care teams, and ongoing evaluation of interventions.

The candidate should hold an RN license (or multi-state eNLC) with 5+ years in case management or related areas and will pursue CCM certification within 36 months of hire.