Remote RN Case Manager: Complex Care Navigator

Highmark Health; Alabama; Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor progress for optimal health outcomes. The role emphasizes cost-effective care and collaboration with physicians, providers, and care teams.

The position requires strong clinical assessment, care planning, and advocacy skills, with a focus on compliant documentation and mentor support for junior staff.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management experience.
• Current State RN licensure OR multi-state licensure via eNLC.
• CCM certification must be obtained within 36 months of hire (exempt for incumbents as of Aug 2026).
• Preferred: transplant-specific clinical experience.
• Preferred: experience with diverse populations and cultural competency.

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 with members, physicians and providers.
• Coordinate and implement care plans ensuring access to services and resources.
• Monitor progress and adjust plans to achieve goals and outcomes.
• Act as an advocate and liaison to promote quality, cost-effective outcomes.
• Document activities in compliance with policies and regulations.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

Microsoft Office

Electronic health records

Education

High School/GED

Bachelor's in Nursing

Tools

Case management software

EHR systems

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor progress for optimal health outcomes. The role emphasizes cost-effective care and collaboration with physicians, providers, and care teams.

The position requires strong clinical assessment, care planning, and advocacy skills, with a focus on compliant documentation and mentor support for junior staff.