Oncology RN Case Manager - Remote/Hybrid Expert

Highmark Health; Jackson (MS); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking an experienced Case Manager to coordinate comprehensive care for members with complex health needs. You will assess, plan, implement, and monitor care while containing costs and ensuring quality outcomes across the network.

The role requires RN licensure (State or eNLC) and CCM certification within 36 months, with at least 5 years in case management or related fields. Office-based or remote work options are available, with occasional travel.

Qualifications

• 5 years in clinical, case/utilization management, disease condition management, or health insurance.
• RN licensure in good standing or multi-state licensure (eNLC).
• CCM certification must be obtained within 36 months of hire.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs, and resources.
• Develop individualized care plans with members and providers.
• Coordinate access to services and resources.
• Monitor progress and adjust care plans as needed.
• Evaluate intervention effectiveness.
• Advocate and coordinate care to meet member needs.
• Collaborate with physicians, providers, and team members.
• Ensure documentation complies with policies and regulations.
• Provide guidance to lower-level Case Managers.
• Be a clinical resource for problem solving.

Education

High School/GED

Bachelors in Nursing

RN licensure or eNLC

CCM certification (must obtain within 36 months)

Tools

Microsoft Office

EHR systems

Case management software

Job description

Highmark Inc. is seeking an experienced Case Manager to coordinate comprehensive care for members with complex health needs. You will assess, plan, implement, and monitor care while containing costs and ensuring quality outcomes across the network.

The role requires RN licensure (State or eNLC) and CCM certification within 36 months, with at least 5 years in case management or related fields. Office-based or remote work options are available, with occasional travel.