Remote Senior Case Manager RN: Care & Outcomes

Highmark Health; Charleston (WV); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services for members, ensuring quality and cost-effective care delivery. The role involves assessing needs, developing care plans, coordinating services, and monitoring progress while containing costs.

Required 5 years of relevant experience, RN licensure (or multi-state eNLC) and CCM certification within 36 months. Travel up to 25% and occasional remote work are possible.

Qualifications

• 5+ years in clinical, case/utilization management, and/or disease condition management or provider operations/health insurance.
• RN licensure in the state or multi-state licensure via the enhanced Nurse Licensure Compact (eNLC); CCM certification within 36 months of hire.
• Bachelor's degree in Nursing preferred; additional clinical certifications welcomed.

Responsibilities

• Manage a caseload of members with complex health needs and develop/coordinate care plans.
• Assess health status, needs, and resources; collaborate with members, physicians and providers.
• Implement, monitor and adjust care plans to ensure access to services and optimal outcomes.
• Advocate and liaison to meet members' individual health care needs while controlling costs.
• Document activities in compliance with HIPAA, policies and accreditation standards.
• Mentor and provide clinical guidance to lower-level Case Managers.

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services for members, ensuring quality and cost-effective care delivery. The role involves assessing needs, developing care plans, coordinating services, and monitoring progress while containing costs.

Required 5 years of relevant experience, RN licensure (or multi-state eNLC) and CCM certification within 36 months. Travel up to 25% and occasional remote work are possible.