Remote RN Case Manager: Complex Care & Advocacy

Highmark Health; Central City (KY); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services to members, developing and implementing care plans, coordinating services, and monitoring progress to promote quality, cost-effective outcomes.

The role requires five years of clinical or case management experience, strong collaboration with physicians and providers, and compliance with HIPAA and company policies; office-based or remote with occasional on-site duties.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.
• Experience coordinating complex care plans with physicians and providers.
• Ability to document activities in compliance with HIPAA and company policies.

Responsibilities

• Manage a caseload of members with complex health needs, requiring advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• 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.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Advocate and liaison to meet members’ health care needs using available resources to promote quality and cost-effective outcomes.
• Collaborate with physicians, providers, co-workers, and health care team to carry out the plan of care.
• Document all activities in compliance with regulations and company policies.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.
• Other duties as assigned.

Skills

Clinical assessment

Care planning

Leadership

Mentoring

Negotiation

Advocacy

Microsoft Office

EHR systems

Healthcare systems

Case management

Education

High School/GED

Bachelor's in Nursing

Tools

Case management software

Electronic health records

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services to members, developing and implementing care plans, coordinating services, and monitoring progress to promote quality, cost-effective outcomes.

The role requires five years of clinical or case management experience, strong collaboration with physicians and providers, and compliance with HIPAA and company policies; office-based or remote with occasional on-site duties.