Remote Oncology Case Manager RN - Expert Care Coordinator

Highmark Health; Phoenix (AZ); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a seasoned Case Manager to deliver comprehensive case management services to members, coordinating care plans and monitoring outcomes while containing healthcare costs.

The role emphasizes clinical assessment, collaboration with physicians and care teams, and mentoring junior staff. An RN license is required, with CCM certification pursued within 36 months; growth opportunities exist within a mission-driven health system.

Qualifications

• 5 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.
• Specialty specific clinical experience (e.g., Oncology, Transplant, Maternity, NICU, Pediatric) preferred.
• Experience working with diverse populations and culture competency is preferred.
• Advanced training in CBT, motivational interviewing, or DBT is preferred.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet health care needs per contract benefits.
• Collaborate with physicians, providers, and the health care team to carry out the plan.
• Document all activities in line with policies, regulatory requirements and accreditation standards.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

Advocacy

EHR proficiency

Microsoft Office

Education

High School/GED

Bachelor's in Nursing

Tools

Case management software

Electronic Health Records

Microsoft Office Suite

Job description

Highmark Health is seeking a seasoned Case Manager to deliver comprehensive case management services to members, coordinating care plans and monitoring outcomes while containing healthcare costs.

The role emphasizes clinical assessment, collaboration with physicians and care teams, and mentoring junior staff. An RN license is required, with CCM certification pursued within 36 months; growth opportunities exist within a mission-driven health system.