Remote RN Case Manager Lead — Complex Care & Advocacy

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

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services for members with complex health needs. You will assess needs, formulate and monitor care plans, and coordinate services to promote quality, cost-effective outcomes.

You will collaborate with physicians and other healthcare providers, document activities, and mentor junior staff while ensuring compliance with policies and regulations. This position may involve remote capability and travel as needed.

Qualifications

• Experience in case/utilization management or disease condition management.
• Strong clinical assessment and care planning abilities.
• Ability to collaborate with physicians and healthcare teams.
• Knowledge of HIPAA and healthcare regulations.

Responsibilities

• Manage a caseload of members with complex health needs and coordinate care.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs, and resources; adjust plans as needed.
• Collaborate with members, physicians, and providers to implement plans.
• Document activities to comply with business policies and regulations.
• Mentor and guide lower-level Case Managers.

Skills

Clinical assessment

Care planning

Leadership & mentoring

Negotiation & advocacy

Healthcare systems knowledge

Education

High School/GED

Bachelor's in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records (EHR)

Job description

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services for members with complex health needs. You will assess needs, formulate and monitor care plans, and coordinate services to promote quality, cost-effective outcomes.

You will collaborate with physicians and other healthcare providers, document activities, and mentor junior staff while ensuring compliance with policies and regulations. This position may involve remote capability and travel as needed.