Remote RN Case Manager - Care Coordination

Highmark Health Company; Pennsylvania; Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is recruiting a Case Manager RN for remote work across PA, MD, WA, NC and LA. The role focuses on comprehensive case management, coordinating services and monitoring outcomes to control healthcare costs.

Required 3 years of relevant experience with a PA RN license or equivalent multi-state licensure. Strong assessment, care planning and collaboration skills are essential for delivering patient-centered care.

Qualifications

• RN nursing license in PA or multi-state licensure (eNLC) within 6 months
• 3 years in clinical, case/utilization management, disease management, or health insurance operations
• BSN preferred; bachelor's degree in nursing encouraged

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members' health status, needs and resources.
• Develop and implement individualized care plans in collaboration with members, physicians and providers.
• Coordinate referrals to specialists and community resources and monitor progress.
• Evaluate interventions for effectiveness and adjust plans as needed.
• Advocate and liaise to meet members' healthcare needs while ensuring compliance with policies and regulations.

Skills

Assessment and care planning

Team collaboration

Microsoft Office / EHR proficiency

Education

Bachelor's Degree in Nursing

High School Diploma/GED

Tools

Case management software

Electronic Health Records

Job description

Highmark Inc. is recruiting a Case Manager RN for remote work across PA, MD, WA, NC and LA. The role focuses on comprehensive case management, coordinating services and monitoring outcomes to control healthcare costs.

Required 3 years of relevant experience with a PA RN license or equivalent multi-state licensure. Strong assessment, care planning and collaboration skills are essential for delivering patient-centered care.