Remote Senior Case Manager RN - Care Coordination Leader

Highmark Health; Athens (GA); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. seeks a skilled Case Manager to deliver comprehensive case management for members, coordinating care plans, services and resources while containing healthcare costs and promoting optimal outcomes.

Requires RN licensure (state or multi-state via eNLC) with CCM certification within 36 months, 5 years of related experience, and the ability to work in office or remotely. Travel is under 25%.

Qualifications

• 5 years in clinical or case management or health insurance experience.
• Transplant-specific clinical experience preferred.
• Experience with diverse populations and cultural competency.
• Advanced training in CBT, motivational interviewing, or DBT.

Responsibilities

• Manage a caseload of members with complex health needs.
• Develop and implement comprehensive, individualized care plans.
• Coordinate services and monitor progress toward goals.
• Advocate for members to ensure quality, cost-effective care.
• Collaborate with physicians and healthcare providers.
• Document activities in compliance with policies and regulations.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a clinical resource for problem-solving.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

EHR proficiency

Healthcare systems

Education

High School/GED

Bachelors in Nursing

Tools

Microsoft Office

Case management software

Electronic health records

Job description

Highmark Inc. seeks a skilled Case Manager to deliver comprehensive case management for members, coordinating care plans, services and resources while containing healthcare costs and promoting optimal outcomes.

Requires RN licensure (state or multi-state via eNLC) with CCM certification within 36 months, 5 years of related experience, and the ability to work in office or remotely. Travel is under 25%.