Remote RN Case Manager - Complex Care & Cost Management

Highmark Health; Bismarck (ND); Hybrid; USD 86,000 - 139,000; Full time

Job summary

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services to members, coordinating care and monitoring progress to ensure quality and cost-effective outcomes. The role emphasizes collaboration with physicians and care teams to develop individualized plans.

The position requires a RN license, CCM certification within 36 months, and 7 years of relevant experience in clinical or utilization management.

Qualifications

• 7 years of experience in clinical, case/utilization management, disease condition management, or health insurance related roles.
• Experience working with diverse populations and cultural competency in addressing populations.
• Advanced training in CBT, motivational interviewing (MI) or dialectical behavior therapy (DBT) is preferred.

Responsibilities

• Provide case management services to members with complex needs across transplantation, oncology, pediatrics, cardiology and other conditions.
• Develop and implement individualized care plans in collaboration with members, physicians and other healthcare providers.
• Coordinate access to services and monitor progress toward goals while controlling costs.
• Act as advocate and liaison to meet members' health care needs using available resources and contract benefits.
• Ensure documentation complies with policies, regulations and accreditation standards.
• Serve as SME and provide training to other case managers.

Skills

Care management

Healthcare systems

Analytical skills

Microsoft Office & EHR

Communication & presentation

Generative AI

Data interpretation

Education

Bachelor’s degree in Nursing or equivalent

RN licensure (state or eNLC)

CCM certification (within 36 months)

Tools

Case management software

Electronic Health Records

Job description

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services to members, coordinating care and monitoring progress to ensure quality and cost-effective outcomes. The role emphasizes collaboration with physicians and care teams to develop individualized plans.

The position requires a RN license, CCM certification within 36 months, and 7 years of relevant experience in clinical or utilization management.