Remote RN Case Manager: Complex Care Strategy

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

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services for members, focusing on quality and cost-effective care delivery. Responsibilities include assessing needs, developing and coordinating care plans, and monitoring progress to ensure optimal health outcomes while containing healthcare costs.

The role requires managing complex cases, collaborating with physicians and providers, and ensuring documentation aligns with policies and regulations.

Qualifications

• 5 years in clinical, case/utilization, and/or disease condition management experience.
• Current State RN licensure OR current multi-state licensure through the eNLC.
• Certified Case Manager (CCM) certification must be obtained within 36 months of hire; incumbents in the role as of August 2026 are exempt from this requirement.

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 in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services.
• Work collaboratively and communicate clearly and professionally with physicians, providers, co-workers and other members of the health care team to carry out the established plan of care.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements, company policies, regulatory requirements and accreditation standards.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.
• Other duties as assigned or requested.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

Advocacy

EMR/EHR

Microsoft Office

Case management software

Electronic health records

Education

High School/GED

Bachelors in Nursing

Tools

Case management software

Electronic health records

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services for members, focusing on quality and cost-effective care delivery. Responsibilities include assessing needs, developing and coordinating care plans, and monitoring progress to ensure optimal health outcomes while containing healthcare costs.

The role requires managing complex cases, collaborating with physicians and providers, and ensuring documentation aligns with policies and regulations.