Remote RN Case Manager — Complex Care & Outcomes

Highmark Health; Provo (UT); Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services, assess members, and develop and coordinate care plans that optimize outcomes while containing costs. You will monitor progress, coordinate services, and advocate for members in collaboration with the health care team.

Ideal candidates have 5+ years in clinical or case management, licensure as an RN, CCM certification within 36 months, and strong EHR/case management software proficiency.

Qualifications

• 5 years in clinical, case/utilization management or related health ops.
• Experience with diverse populations in healthcare.
• Advanced training in CBT, motivational interviewing or DBT.
• Expertise in clinical assessment and care planning.
• Proficient with MS Office and EHR/case management software.
• Strong knowledge of healthcare systems and case management principles.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop care plans.
• Coordinate services and monitor progress toward goals.
• Advocate and liaison to meet individual health care needs.
• Collaborate with physicians and providers to execute plans.
• Ensure documentation aligns with policies and regulations.
• Mentor lower-level Case Managers and provide clinical guidance.

Skills

Clinical assessment

Care planning

CBT

Motivational interviewing

DBT

Microsoft Office

EHR familiarity

Case management software

Healthcare systems knowledge

Communication

Education

RN licensure

eNLC licensure

CCM certification

Tools

Microsoft Office

EHR systems

Case management software

Job description

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services, assess members, and develop and coordinate care plans that optimize outcomes while containing costs. You will monitor progress, coordinate services, and advocate for members in collaboration with the health care team.

Ideal candidates have 5+ years in clinical or case management, licensure as an RN, CCM certification within 36 months, and strong EHR/case management software proficiency.