Remote Medical Case Manager – Care Coordination & Advocacy

Highmark Health Company; New York (NY); Hybrid; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a full-time Case Manager to deliver comprehensive case management services within the assigned territory in DE.

The role involves assessing member needs, developing and implementing care plans, coordinating services, and monitoring progress to ensure quality and cost-effective care. You will detect and prevent improper utilization of benefits while collaborating with physicians and the health care team to meet member goals.

Qualifications

• 3 years of experience in case or utilization management or health insurance with RN licensure or a MSW.
• 5 years of experience with a Bachelor’s in Social Work.
• Pediatric, Medicaid/Medicare experience, and cultural competence in care.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans with members, physicians, and other providers.
• Coordinate referrals to specialists and community resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Ensure documentation complies with policies and HIPAA and related regulations.
• Identify areas for cost savings, quality improvement, and workflow efficiencies.
• Collaborate with the health care team to carry out the plan of care.

Skills

Assessment & care planning

Independent & team work

MS Office & EHR

Healthcare systems knowledge

Bilingual English/Spanish

Education

Nursing degree or RN licensure

MSW or Social Work degree

Tools

Case management software

Electronic Health Records (EHRs)

Job description

Highmark Inc. is seeking a full-time Case Manager to deliver comprehensive case management services within the assigned territory in DE.

The role involves assessing member needs, developing and implementing care plans, coordinating services, and monitoring progress to ensure quality and cost-effective care. You will detect and prevent improper utilization of benefits while collaborating with physicians and the health care team to meet member goals.