Remote RN Case Manager Lead – Complex Care

Highmark Health; Arkansas; Remote; USD 79.000 - 127.000; Vollzeit

Zusammenfassung

Highmark Health is seeking an experienced Case Manager to deliver comprehensive case management services for members, coordinating care plans across physicians and providers to promote optimal health outcomes. You will assess needs, develop and implement plans, monitor progress, and advocate for cost-effective, quality care within contract benefits.

The role requires strong clinical knowledge, leadership, and ability to mentor junior staff while maintaining rigorous documentation and compliance

Qualifikationen

• 5 years in clinical, case/utilization management, or disease condition management experience.
• Experience coordinating complex member care plans with physicians and providers.
• Ability to advocate for optimal, cost-effective care outcomes.
• Strong knowledge of healthcare systems and case management principles.
• Capability to mentor and guide junior staff.

Aufgaben

• Manage a caseload of members with complex health needs and advanced clinical requirements.
• Conduct comprehensive assessments and develop complex care plans.
• Coordinate care plans and ensure access to required services.
• Monitor progress toward goals and adjust plans as needed.
• Evaluate intervention effectiveness and outcomes for quality improvement.
• Act as liaison to meet members' health care needs, communicating with the care team.
• Document activities in compliance with policies and regulatory standards.
• Provide guidance and mentorship to junior Case Managers.

Kenntnisse

Clinical assessment

Care planning

Leadership

Advocacy

Microsoft Office

EHR systems

Ausbildung

High School/GED

Bachelors in Nursing

RN licensure

CCM certification within 36 months

Tools

Case management software

Electronic Health Records (EHR)

Jobbeschreibung

Highmark Health is seeking an experienced Case Manager to deliver comprehensive case management services for members, coordinating care plans across physicians and providers to promote optimal health outcomes. You will assess needs, develop and implement plans, monitor progress, and advocate for cost-effective, quality care within contract benefits.

The role requires strong clinical knowledge, leadership, and ability to mentor junior staff while maintaining rigorous documentation and compliance