Remote RN Case Manager: Care Coordination & Outcomes

Highmark Health Company; Pierre (SD); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a dedicated Case Manager to provide comprehensive case management services, coordinate care, and promote cost-effective health outcomes.

You will assess member needs, develop care plans, and monitor progress in collaboration with physicians and care teams. Responsibilities include managing moderate complexity caseloads, coordinating referrals, and ensuring documentation complies with HIPAA and company policies.

Qualifications

• Requires active RN licensure and 3 years of related experience.
• Experience with diverse patient populations is preferred.
• Strong documentation, communication, and problem-solving skills.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• 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.
• Develop and implement care plans with guidance from senior staff.
• Coordinate referrals to specialists and community resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Advocate for members and coordinate with care teams to meet health plan benefits.

Skills

Assessment & care planning

Team collaboration

Microsoft Office & EHRs

Healthcare systems knowledge

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

Case management software

Electronic Health Records

Job description

Highmark Inc. is seeking a dedicated Case Manager to provide comprehensive case management services, coordinate care, and promote cost-effective health outcomes.

You will assess member needs, develop care plans, and monitor progress in collaboration with physicians and care teams. Responsibilities include managing moderate complexity caseloads, coordinating referrals, and ensuring documentation complies with HIPAA and company policies.