Remote Health Case Manager (Travel Optional)

Highmark; United States; Hybrid; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services to members, coordinating care plans and services to promote quality, cost-effective outcomes.

The role requires assessing member health needs, developing individualized care plans with clinicians, coordinating referrals, and monitoring progress while ensuring compliance with policies and HIPAA requirements. Travel to facilities, member homes, and our main office in Wilmington is required 0-25% per the job

Qualifications

• 3 years of relevant experience with RN licensure or MSW, or 5 years with BS in Social Work

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and resources.
• Develop individualized care plans with members, physicians, and providers.
• Coordinate referrals to specialists and community resources.
• Monitor progress toward goals and adjust care plans as needed.

Skills

Assessment & care planning

Independent work & teamwork

MS Office / EHR software

Healthcare systems knowledge

Bilingual English/Spanish

Education

Bachelor’s degree in nursing / RN licensure / MSW or related field

Tools

Case management software

Electronic Health Records (EHR)

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services to members, coordinating care plans and services to promote quality, cost-effective outcomes.

The role requires assessing member health needs, developing individualized care plans with clinicians, coordinating referrals, and monitoring progress while ensuring compliance with policies and HIPAA requirements. Travel to facilities, member homes, and our main office in Wilmington is required 0-25% per the job