Remote Oncology Case Manager RN - Complex Care

Highmark Health; Salem (NH); Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a qualified Case Manager to provide comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor outcomes. The role focuses on containing costs while delivering quality, evidence-based care in collaboration with a multidisciplinary team.

Required RN licensure and 36-month CCM certification timeline, with 5 years of relevant experience and proficiency in EHR/case management tools. On-site role based in New Hampshire.

Qualifications

• 5 years in clinical, case/utilization management, or health insurance experience.
• RN licensure (State) REQUIRED or multi-state eNLC.
• CCM certification must be obtained within 36 months of hire.
• Experience with diverse populations preferred.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs, and resources.
• Collaborate with members, physicians, and providers to create individualized care plans.
• Coordinate and monitor care plans to ensure access to services.
• Follow up on progress and adjust plans as needed.
• Advocate for members to meet health care needs within benefits.
• Communicate with physicians, providers, and team members to implement plan.
• Ensure documentation complies with policies and regulatory requirements.
• Provide guidance to lower-level Case Managers.
• Serve as clinical resource for problem-solving.

Skills

Case management

Patient advocacy

Clinical assessment

Care planning

CBT/DBT/MI

Microsoft Office

EHR software

Healthcare systems

Diverse populations

Education

Bachelors in Nursing

Tools

Case management software

Electronic health records

Job description

Highmark Health is seeking a qualified Case Manager to provide comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor outcomes. The role focuses on containing costs while delivering quality, evidence-based care in collaboration with a multidisciplinary team.

Required RN licensure and 36-month CCM certification timeline, with 5 years of relevant experience and proficiency in EHR/case management tools. On-site role based in New Hampshire.