Oncology Case Manager RN - Remote Care Leader

Highmark Health; Carson City (NV); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a skilled Case Manager to deliver comprehensive case management services to members, promoting quality and cost-effective care within contract benefits.

You will assess needs, develop and coordinate care plans, monitor progress, and advocate for members while ensuring compliance with HIPAA and company policies. The role requires five years of experience in clinical or utilization management, RN licensure (state or multi-state via eNLC), and CCM certification within 36

Qualifications

• 5 years in clinical, case/utilization, and/or disease management roles.
• RN licensure in state or multi-state via eNLC.
• CCM certification within 36 months of hire.
• Experience with diverse populations and culture competency.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members and providers.
• Implement and coordinate care plans, ensuring access to services.
• Monitor progress toward goals and adjust plans as needed.
• Evaluate the effectiveness of interventions and services.
• Advocate and coordinate options to promote quality, cost-effective outcomes.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

EHR proficiency

Education

High School/GED

Bachelor's in Nursing

Tools

Microsoft Office

Case management software

Electronic health records

Job description

Highmark Inc. is seeking a skilled Case Manager to deliver comprehensive case management services to members, promoting quality and cost-effective care within contract benefits.

You will assess needs, develop and coordinate care plans, monitor progress, and advocate for members while ensuring compliance with HIPAA and company policies. The role requires five years of experience in clinical or utilization management, RN licensure (state or multi-state via eNLC), and CCM certification within 36