Remote Medical Case Manager & Care Navigator

Highmark Inc; Pennsylvania; Hybrid; USD 73,000 - 117,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services to members, coordinating care plans and resources to promote quality and cost-effective outcomes. You will assess needs, develop plans with physicians and providers, monitor progress, and advocate for members while ensuring compliance with policies.

The role supports a diverse population, requires RN licensure or MSW, 3 years of experience, and proficiency with case management software and EHR systems.

Qualifications

• 3 years of relevant case management or clinical experience.
• RN licensure or MSW; 3 years experience required; Bachelor's preferred in Medicaid/Medicare.
• Experience with diverse populations and cultural competency.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess health status, needs, and resources.
• Develop individualized care plans with members and providers.
• Coordinate referrals to specialists and resources.
• Monitor progress and adjust plans as needed.
• Ensure activities documented per policies and compliance.
• Identify opportunities for cost savings and quality improvements.

Skills

Assessment & care planning

Independent worker

Team collaboration

Bilingual English/Spanish

Education

Nursing RN license or SW degree

Tools

Microsoft Office

Case management software

Electronic health records

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services to members, coordinating care plans and resources to promote quality and cost-effective outcomes. You will assess needs, develop plans with physicians and providers, monitor progress, and advocate for members while ensuring compliance with policies.

The role supports a diverse population, requires RN licensure or MSW, 3 years of experience, and proficiency with case management software and EHR systems.