Remote RN Case Manager — Complex Care & Advocacy

Highmark; United States; On-site; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking an experienced Case Manager to provide comprehensive case management services to members, develop and implement care plans, and coordinate services to promote optimal health outcomes.

You will assess member needs, monitor progress, and act as an advocate to contain costs while delivering high-quality care. This role requires strong clinical knowledge, leadership, and collaboration with the health care team.

Qualifications

• Experience in clinical case management and utilization management.
• Knowledge of health care delivery systems and payer policies.
• Ability to mentor junior case managers and provide guidance.

Responsibilities

• Manage a caseload of members with complex health needs and develop care plans.
• Coordinate services and monitor progress to achieve quality outcomes.
• Advocate for members and ensure compliance with policies and regulatory requirements.
• Document activities and maintain accurate records across systems.
• Collaborate with physicians, providers and care-team members to implement plans.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

MS Office & EHR

Healthcare systems knowledge

Education

High School/GED

Bachelors in Nursing

Tools

Microsoft Office

EHR systems

Case management software

Job description

Highmark Inc. is seeking an experienced Case Manager to provide comprehensive case management services to members, develop and implement care plans, and coordinate services to promote optimal health outcomes.

You will assess member needs, monitor progress, and act as an advocate to contain costs while delivering high-quality care. This role requires strong clinical knowledge, leadership, and collaboration with the health care team.