Oncology RN Case Manager — Complex Care & Coordination

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

Benefits offered by this job

Health insurance

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services, ensuring quality and cost-effective care, and promoting optimal health outcomes.

The role involves assessing member needs, developing and implementing care plans, coordinating services, monitoring progress, and containing costs by preventing improper utilization of benefits, while documenting all activities in compliance with policies.

Qualifications

• Current state RN licensure or multi-state licensure via eNLC.
• CCM certification must be obtained within 36 months of hire.
• 5 years of clinical/case management or related health insurance experience.
• Experience with diverse populations in healthcare settings.
• Strong knowledge of CBT/MI/DBT techniques.
• Proficiency with case management software and EHR systems.
• Bachelor's degree in Nursing.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop care plans.
• Assess health status, needs and available resources.
• Coordinate care with physicians and other providers.
• Implement and monitor care plans and adjust as needed.
• Advocate for members and contain costs by appropriate utilization.
• Document activities in line with policies and regulations.
• Provide guidance to lower-level Case Managers.
• Serve as a clinical resource for problem-solving.

Skills

Clinical assessment

Care planning

Collaboration with physicians

Documentation in EHR

CBT/MI/DBT techniques

Regulatory/compliance

Communication skills

Education

Bachelor's in Nursing

Tools

Case management software

Electronic Health Records (EHR)

Microsoft Office

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services, ensuring quality and cost-effective care, and promoting optimal health outcomes.

The role involves assessing member needs, developing and implementing care plans, coordinating services, monitoring progress, and containing costs by preventing improper utilization of benefits, while documenting all activities in compliance with policies.