Oncology RN Case Manager — Remote Care Leader

Highmark Health; Austin (TX); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. seeks a qualified Case Manager to provide comprehensive case management services for members, focusing on quality, cost-effective care delivery and optimal health outcomes.

The role involves assessments, care plan development, coordination of services, and ongoing progress monitoring to contain healthcare costs. The position requires an active RN license, 5 years of experience in clinical or utilization management, and CCM certification within 36 months of hire (exemption for

Qualifications

• 5 years in clinical, case/utilization management, disease condition management, or health insurance related roles.
• Preferred: Oncology, Transplant, Maternity, NICU, Pediatric clinical experience.
• Experience with diverse populations and cultural competency.
• Advanced training in CBT, motivational interviewing, or DBT.

Responsibilities

• Manage a caseload of members with complex health needs and advanced clinical requirements.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs, and available resources for members.
• Develop individualized care plans with input from members, physicians and providers.
• Coordinate and monitor care plans to ensure access to services and resources.
• Document activities and maintain compliance with policies and regulations.
• Act as an advocate and liaison to promote quality, cost-effective outcomes.
• Collaborate with physicians, providers and the health care team to execute the plan.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

EHR proficiency

Microsoft Office

Healthcare systems

Education

High School/GED

Bachelors in Nursing

Tools

Case management software

Electronic Health Records (EHR)

Job description

Highmark Inc. seeks a qualified Case Manager to provide comprehensive case management services for members, focusing on quality, cost-effective care delivery and optimal health outcomes.

The role involves assessments, care plan development, coordination of services, and ongoing progress monitoring to contain healthcare costs. The position requires an active RN license, 5 years of experience in clinical or utilization management, and CCM certification within 36 months of hire (exemption for