Remote Senior Case Manager RN: Complex Care & Advocacy

Highmark Health

Sacramento (CA)

Hybrid

USD 79,000 - 127,000

Full time

6 days ago

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Job summary

Highmark Inc. in California seeks a Case Manager to deliver comprehensive case management services, coordinate care, and contain costs. The role requires at least 5 years of clinical or utilization management experience and RN licensure or eNLC, with CCM certification within 36 months.

Office-based or remote work is possible with travel under 25%. You will collaborate with physicians and care teams, develop individualized care plans, monitor progress, and ensure documentation aligns with HIPAA

Qualifications

5 years minimum in clinical, case/utilization or disease management related roles.
Experience working with diverse populations and hospital/clinic settings.
Understanding of HIPAA and healthcare compliance requirements.

Responsibilities

Manage a caseload of members with complex health needs and coordinate care.
Develop and implement individualized care plans with providers.
Monitor progress, evaluate outcomes, and adjust plans as needed.
Advocate for members and communicate with care teams to ensure access to services.
Document activities in compliance with policies and standards.