Oncology RN Case Manager Lead — Remote

Highmark Health; Massachusetts; Híbrido; USD 79 000 - 127 000; Tempo integral

Resumo da oferta

Highmark Health seeks a Case Manager to provide comprehensive case management services for members, coordinating care plans and resources to ensure quality, cost-effective care. The role emphasizes collaboration with physicians and the health care team to promote optimal outcomes and containment of unnecessary costs.

The position requires five years of related experience, RN licensure, and CCM certification within 36 months of hire, with remote option and potential travel as needed.

Qualificações

• 5 years in clinical, case/utilization management, disease condition management, or health insurance operations.
• Current State RN licensure or multi-state licensure via eNLC.
• CCM certification must be obtained within 36 months of hire; exempts apply for Aug 2026 hires.

Responsabilidades

• Manage a caseload of members with complex health needs and advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• Coordinate services and monitor progress toward goals.
• Advocate for members and collaborate with physicians and care teams.
• Ensure documentation complies with HIPAA, policies, and accreditation standards.

Conhecimentos

Clinical assessment

Care planning

Leadership & mentoring

Negotiation & advocacy

MS Office & EHR proficiency

Formação académica

High School/GED

Bachelor's in Nursing

Ferramentas

Case management software

Electronic Health Records (EHR)

Descrição da oferta de emprego

Highmark Health seeks a Case Manager to provide comprehensive case management services for members, coordinating care plans and resources to ensure quality, cost-effective care. The role emphasizes collaboration with physicians and the health care team to promote optimal outcomes and containment of unnecessary costs.

The position requires five years of related experience, RN licensure, and CCM certification within 36 months of hire, with remote option and potential travel as needed.