Remote Medical Case Manager — Care Coordination Leader

Highmark Health; United States; À distance; USD 73 000 - 117 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a dedicated Case Manager to provide comprehensive case management services for members. The role involves coordinating care plans, traveling to facilities and member homes, and ensuring cost-effective, high-quality health outcomes.

You will assess needs, develop individualized plans with physicians and providers, and monitor progress while advocating for members and navigating clinical and administrative requirements. Strong collaboration and documentation are essential.

Qualifications

• 3 years of experience in case/utilization management or health insurance with RN licensure or a Master’s in Social Work, or 5 years with a BA in Social Work.
• Preferred Medicaid/Medicare experience and working with diverse populations.
• Bilingual English/Spanish preferred.

Responsabilités

• Manage a caseload of members with moderate complexity health needs.
• Assess health status, needs and available resources.
• Develop individualized care plans with members and providers.
• Coordinate care plans and ensure access to services.
• Monitor progress and adjust plans to achieve goals.
• Identify cost-saving and quality-improvement opportunities.

Connaissances

Case management skills

Independent worker

Bilingual English/Spanish

Microsoft Office Suite

Electronic health records

Formation

Bachelor’s degree in nursing or RN licensure or MSW-related Master’s

Bachelor’s degree in Social Work

Outils

Case management software

Electronic health records (EHR)

Microsoft Office Suite

Description du poste

Highmark Inc. is seeking a dedicated Case Manager to provide comprehensive case management services for members. The role involves coordinating care plans, traveling to facilities and member homes, and ensuring cost-effective, high-quality health outcomes.

You will assess needs, develop individualized plans with physicians and providers, and monitor progress while advocating for members and navigating clinical and administrative requirements. Strong collaboration and documentation are essential.