Remote RN Case Manager Leader – Complex Care

Santa Barbara Cottage Hospital; United States; Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services to members, coordinating care plans and monitoring progress to promote optimal health outcomes.

The role requires 5 years of relevant experience, RN licensure, and CCM certification within 36 months of hire. Responsibilities include assessing needs, developing plans, and ensuring cost-effective care within contract benefits.

Qualifications

• 5 years in clinical, case/utilization management, or disease condition management experience.
• RN licensure (current) OR multi-state licensure via eNLC.
• CCM certification must be obtained within 36 months of hire (incumbents as of Aug 2026 exempt).

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 resources; coordinate and monitor progress.
• Develop individualized care plans with members, physicians, and other providers.
• Ensure all activities are documented in compliance with HIPAA, policies, and standards.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

EHR systems

Education

High School/GED

Bachelor's in Nursing (preferred)

Tools

Microsoft Office

Case management software

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services to members, coordinating care plans and monitoring progress to promote optimal health outcomes.

The role requires 5 years of relevant experience, RN licensure, and CCM certification within 36 months of hire. Responsibilities include assessing needs, developing plans, and ensuring cost-effective care within contract benefits.