Remote RN Case Manager Lead - Complex Care

Highmark Health; West Virginia; Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Health in the United States is seeking a Case Manager to deliver comprehensive case management for members, coordinating care plans and monitoring progress to ensure quality, cost-effective outcomes.

The role requires 5 years of clinical or utilization management experience, RN licensure (or multi-state eNLC) and CCM certification within 36 months. Office-based or remote position with travel under 25%.

Qualifications

• 5 years in clinical, case/utilization management, disease condition management, or related health insurance experience.
• Transplant clinical experience is preferred.
• Experience with diverse populations and cultural competency is preferred.
• Advanced training in CBT, motivational interviewing, or DBT is a plus.

Responsibilities

• Manage a caseload of members with complex health needs and advanced clinical knowledge.
• Conduct assessments and develop complex care plans.
• Assess health status, needs, and resources; coordinate services and monitor progress.
• Collaborate with members, physicians and providers to implement and adjust care plans.
• Ensure documentation complies with policies, regulations and accreditation standards.
• Mentor lower-level Case Managers and provide clinical guidance.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

EHR systems

Education

High School/GED

Bachelors in Nursing

Tools

Microsoft Office

Case management software

Electronic health records

Job description

Highmark Health in the United States is seeking a Case Manager to deliver comprehensive case management for members, coordinating care plans and monitoring progress to ensure quality, cost-effective outcomes.

The role requires 5 years of clinical or utilization management experience, RN licensure (or multi-state eNLC) and CCM certification within 36 months. Office-based or remote position with travel under 25%.