Remote RN Case Manager — Complex Care & Outcomes

Santa Barbara Cottage Hospital; United States; Hybrid; USD 86,000 - 139,000; Full time

Job summary

Highmark Inc. is seeking a seasoned Case Manager to deliver comprehensive case management services for members with highly complex needs, coordinating care with physicians and care teams to promote optimal health outcomes while containing costs.

The role requires extensive experience in clinical or utilization management and RN licensure, with strong skills in data interpretation, AI tools, and cross-functional collaboration.

Qualifications

• 7 years of experience in clinical, case/utilization management, or disease condition management.
• RN licensure or equivalent (as applicable to the state).

Responsibilities

• Provide case management services to members with complex needs.
• Maintain oversight over a panel of members and assess health management needs.
• Develop and implement strategies to improve outcomes and reduce costs.
• Assess health status, needs and resources.
• Develop individualized care plans with members and providers.
• Coordinate care plans and ensure access to services.
• Monitor progress and adjust plans as needed.
• Evaluate intervention effectiveness.
• Act as advocate and liaison to promote quality and cost-effective outcomes.
• Collaborate with physicians and health care team to execute the plan.

Skills

Case management

Healthcare systems navigation

Analytical skills

MS Office & EHR

Communication skills

Generative AI

Data interpretation

Education

Bachelor’s degree in Nursing or equivalent

Job description

Highmark Inc. is seeking a seasoned Case Manager to deliver comprehensive case management services for members with highly complex needs, coordinating care with physicians and care teams to promote optimal health outcomes while containing costs.

The role requires extensive experience in clinical or utilization management and RN licensure, with strong skills in data interpretation, AI tools, and cross-functional collaboration.