Remote RN Case Manager - Complex Care & Outcomes

Highmark Health

Lexington (KY)

Hybrid

USD 79,000 - 127,000

Full time

6 days ago

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Job summary

Highmark Inc. in Lexington, KY seeks an experienced Case Manager to provide comprehensive case management services to members, coordinating care, promoting quality outcomes, and containing health care costs.

You will assess needs, develop and implement plans, and monitor progress while collaborating with physicians and providers. Requires RN licensure, 5 years of related experience, and CCM certification within 36 months.

Qualifications

5 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.
Transplant specific clinical experience preferred.
Experience working with the healthcare needs of diverse populations.
Advanced training and experience in CBT, motivational interviewing, or DBT preferred.

Responsibilities

Manage a caseload of members with complex health needs.
Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
Assess members' health status, needs, and available resources.
Implement and coordinate care plans, ensuring access to appropriate services and resources.
Monitor member progress toward goals and adjust care plans as needed.
Act as an advocate and liaison to meet a member's individual health care needs while adhering to contract benefits.