Remote RN Case Manager: Complex Care & Advocacy Leader

Highmark Health; Salem (NH); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. seeks a skilled Case Manager to provide comprehensive caseload management for members with complex health needs. You will assess health status, develop and execute plans, coordinate services, and monitor progress to ensure quality and cost-effective care.

Required is 5 years of relevant clinical or utilization management experience, RN licensure or multi-state licensure via eNLC, and CCM certification within 36 months. Office-based or remote work option is available.

Qualifications

• 5 years in clinical, case/utilization management, disease condition mgmt or provider operations/health insurance.
• Experience in transplant care preferred.
• Experience with diverse populations and cultural competency.
• Advanced training in CBT, motivational interviewing or DBT preferred.

Responsibilities

• Manage a caseload of members with complex health needs and advanced clinical knowledge.
• Conduct assessments and develop complex, individualized care plans.
• Coordinate services and monitor progress toward goals.
• Advocate for members and liaise with physicians and providers.
• Document activities in compliance with policies and accreditation standards.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

Negotiation

Communication

Collaboration

Microsoft Office

EHR systems

Education

High School/GED

Bachelors in Nursing

Tools

Case management software

Electronic Health Records (EHR)

Microsoft Office

Job description

Highmark Inc. seeks a skilled Case Manager to provide comprehensive caseload management for members with complex health needs. You will assess health status, develop and execute plans, coordinate services, and monitor progress to ensure quality and cost-effective care.

Required is 5 years of relevant clinical or utilization management experience, RN licensure or multi-state licensure via eNLC, and CCM certification within 36 months. Office-based or remote work option is available.