Remote RN Case Manager — Care Coordination

Highmark Health; Philadelphia (Philadelphia County); Remote; USD 105,000 - 128,000; Full time

Job summary

Highmark Health seeks a Case Manager to deliver comprehensive case management services for members, promoting quality and cost-effective care. You will assess needs, develop care plans, coordinate services, and monitor outcomes while containing costs through proper utilization of benefits.

The role requires RN licensure and experience in clinical or utilization management, with strong collaboration skills and proficiency in EHRs and the Microsoft suite. Office-based Philadelphia work is expected.

Qualifications

• RN licensure (PA or multi-state via eNLC or equivalent)
• Bachelor's Degree in Nursing
• Experience in clinical/case/utilization management or related health insurance roles
• Experience serving diverse populations
• Proficiency with Microsoft Office, case management software, and EHRs
• Understanding of healthcare systems and case management principles

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and available resources.
• Develop and implement individualized care plans with members, physicians, and providers.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust care plans to meet goals.
• Act as advocate and liaison to ensure optimal care within contract benefits.
• Collaborate with physicians and the care team to execute the plan of care.
• Document all activities per policy and regulatory standards.
• Identify opportunities for cost savings, quality improvement, and workflow efficiency.

Skills

Assessment skills

Care planning

Healthcare systems knowledge

EHR proficiency

MS Office

Education

Bachelor's Degree in Nursing

Tools

Microsoft Office

Case management software

Electronic health records (EHR)

Job description

Highmark Health seeks a Case Manager to deliver comprehensive case management services for members, promoting quality and cost-effective care. You will assess needs, develop care plans, coordinate services, and monitor outcomes while containing costs through proper utilization of benefits.

The role requires RN licensure and experience in clinical or utilization management, with strong collaboration skills and proficiency in EHRs and the Microsoft suite. Office-based Philadelphia work is expected.