Remote RN Case Manager: Complex Care & Care Coordination

Highmark Health; Annapolis (MD); Remote; USD 86,000 - 139,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services to members, coordinating care plans and monitoring progress to improve outcomes while containing costs.

You will assess needs, develop individualized care plans with clinicians, and advocate for patients, using data to drive recommendations and ensuring compliance with policies and HIPAA. This office-based or remote role requires RN licensure and CCM certification within 36 months, with a focus on complex

Qualifications

• Bachelor’s degree in Nursing or equivalent experience.
• 7 years of experience in case/utilization management or health insurance settings.
• Experience with diverse populations and cultural competence preferred.
• CBT/MI/DBT training is a plus.

Responsibilities

• Provide case management services to members with complex or specialized needs.
• Maintain oversight over a panel of members and triage resources as needed.
• Develop and implement strategies to improve outcomes and reduce costs.
• Assess member health status, needs, and resources.
• Develop individualized care plans with members, physicians, and providers.
• Coordinate care plans and ensure access to services.
• Monitor progress and adjust plans as needed.
• Evaluate interventions and document outcomes.
• Advocate for members and communicate with the care team per policy.
• Train other case managers as a SME and perform other duties as assigned.

Skills

Care management

Healthcare systems

Analytical skills

EHR / CMA software

Communication skills

Generative AI

Data interpretation

Education

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 to members, coordinating care plans and monitoring progress to improve outcomes while containing costs.

You will assess needs, develop individualized care plans with clinicians, and advocate for patients, using data to drive recommendations and ensuring compliance with policies and HIPAA. This office-based or remote role requires RN licensure and CCM certification within 36 months, with a focus on complex