Remote RN Case Manager - Care Coordination Pro

Highmark Health Company; Annapolis (MD); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services, assess needs, develop and implement care plans, coordinate services, and monitor progress to promote quality and cost-effective health outcomes.

You will collaborate with physicians and the health care team, document activities in compliance with policies, and identify areas for cost savings and quality improvements. Office-based role with travel as needed.

Qualifications

• 3 years in clinical, case/utilization management, and/or disease condition management experience or health insurance operations
• RN licensure (PA) or multi-state licensure via eNLC or WV/DE/NY; must obtain within 6 months

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans with members, physicians, and other healthcare providers.
• Coordinate care plans and ensure access to services and resources.
• Collaborate with senior staff to refine care plans.
• Coordinate referrals to specialists and community resources.
• Monitor progress toward goals and adjust plans as needed.
• Evaluate effectiveness of interventions and services.
• Advocate for members to promote quality, cost-effective outcomes within contract benefits.
• Communicate clearly with physicians, providers, and health care team to execute the plan of care.
• Document activities in compliance with policies and requirements.
• Identify opportunities for cost savings, quality improvement, and workflow efficiency.

Skills

Assessment & care planning

Teamwork & collaboration

MS Office & EMR

Healthcare systems knowledge

Education

High School Diploma

Bachelor's degree in Nursing

Tools

Case management software

Electronic Health Records (EHR)

Microsoft Office

Job description

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services, assess needs, develop and implement care plans, coordinate services, and monitor progress to promote quality and cost-effective health outcomes.

You will collaborate with physicians and the health care team, document activities in compliance with policies, and identify areas for cost savings and quality improvements. Office-based role with travel as needed.