Remote Senior Case Manager RN: Care Coordination Leader

Highmark Health; Topeka (KS); Híbrido; USD 79.000 - 127.000; Jornada completa

Descripción de la vacante

Highmark Inc. seeks a skilled Case Manager to deliver comprehensive case management services, coordinating care for members with complex health needs and monitoring outcomes.

You will assess needs, develop and implement care plans in collaboration with physicians and providers, and advocate for cost-effective, high-quality care while ensuring compliance with policies and HIPAA requirements. Required is RN licensure and CCM preferred; 5+ years of relevant experience; opportunity to mentor junior

Formación

• 5 years in clinical or case/utilization management roles.
• Transplant-specific clinical experience.
• Experience serving diverse populations.
• Advanced training in CBT/MBT/DBT preferred.

Responsabilidades

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Advocate and liaise to meet members’ health care needs, promoting quality, cost-effective outcomes.
• Work with physicians and care teams to carry out the plan of care.
• Ensure activities are documented per policies and standards.
• Provide guidance to lower-level Case Managers.

Conocimientos

Clinical assessment

Leadership

Negotiation

Case management software

Electronic health records

Care management principles

Educación

High School/GED

Bachelors in Nursing

Herramientas

Case management software

Electronic health records

Descripción del empleo

Highmark Inc. seeks a skilled Case Manager to deliver comprehensive case management services, coordinating care for members with complex health needs and monitoring outcomes.

You will assess needs, develop and implement care plans in collaboration with physicians and providers, and advocate for cost-effective, high-quality care while ensuring compliance with policies and HIPAA requirements. Required is RN licensure and CCM preferred; 5+ years of relevant experience; opportunity to mentor junior