Remote Oncology RN Case Manager - Complex Care Leader

Highmark Health; New Hampshire; Hybrid; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services, assess member needs, coordinate care, and monitor progress while containing healthcare costs. You will develop individualized care plans, work with physicians and the health care team, and ensure compliance with policies and HIPAA requirements.

A CCM track or certification is expected within 36 months of hire.

Qualifications

• 5 years in clinical, case/utilization management, or disease condition management experience or provider operations/health insurance experience.
• Oncology, Transplant, Maternity, NICU, Pediatric experience.
• Diverse population experience.
• CBT, motivational interviewing, or DBT training.
• Clinical assessment and care planning expertise.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs and resources.
• Coordinate care plans with members, physicians and providers.
• Implement and coordinate access to services and resources.
• Monitor progress and adjust plans as needed.
• Advocate and liaise to meet health care needs efficiently.

Skills

Case management

Utilization management

Disease management

Provider operations

Health insurance

Education

Bachelors in Nursing

Tools

Microsoft Office

Case management software

Electronic health records

Job description

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services, assess member needs, coordinate care, and monitor progress while containing healthcare costs. You will develop individualized care plans, work with physicians and the health care team, and ensure compliance with policies and HIPAA requirements.

A CCM track or certification is expected within 36 months of hire.