Remote RN Case Manager — Care Planner & Advocate

Highmark Health Company; Providence (RI); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking an experienced Case Manager to provide comprehensive case management services, assess member needs, develop care plans, coordinate services, and monitor outcomes while containing costs.

You will collaborate with physicians and the health care team to ensure access to appropriate services, document activities per policy, and maintain HIPAA and accreditation standards. This role involves office-based work with travel up to 25% as needed.

Qualifications

• 3 years in clinical, case/utilization management, disease management, or health insurance experience
• License in nursing (RN) or equivalent required within specified timeframe
• Bachelor's in Nursing preferred for advanced practice and patient care leadership

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 services and resources.
• 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.
• Act as an advocate and liaison to meet a member’s health care needs per contract benefits.

Skills

Case management

Care planning

Healthcare coordination

Microsoft EHR

Education

Bachelor's degree in Nursing

High School Diploma/GED

Tools

MS Office

Case management software

Electronic Health Records

Job description

Highmark Inc. is seeking an experienced Case Manager to provide comprehensive case management services, assess member needs, develop care plans, coordinate services, and monitor outcomes while containing costs.

You will collaborate with physicians and the health care team to ensure access to appropriate services, document activities per policy, and maintain HIPAA and accreditation standards. This role involves office-based work with travel up to 25% as needed.