Oncology RN Case Manager — Remote Care Coordination Lead

Highmark Health; Hydaburg (AK); Remote; USD 79,000 - 127,000; Full time

Job summary

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

You will assess needs, develop and implement care plans, coordinate services, monitor progress, and advocate for members within contract benefits. Strong collaboration with physicians and the care team is essential, with diligent documentation and compliance.

Qualifications

• 5 years in clinical, case/utilization management, or health insurance experience.
• Experience with complex case management and care coordination.
• Ability to advocate for members and coordinate with providers.

Responsibilities

• 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 care goals.
• Advocate for member needs and ensure cost-effective care within benefits.
• Collaborate with physicians and the health care team to implement plans.
• Document activities in compliance with policies and regulations.

Skills

Case management

Clinical assessment

Care planning

Advocacy

EHR proficiency

Education

High School/GED

Bachelor's in Nursing (preferred)

Tools

Microsoft Office

Case management software

Electronic Health Records (EHR)

Job description

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

You will assess needs, develop and implement care plans, coordinate services, monitor progress, and advocate for members within contract benefits. Strong collaboration with physicians and the care team is essential, with diligent documentation and compliance.