Remote Senior Case Manager RN: Complex Care & Advocacy

Highmark Health; Saint Paul (MN); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a skilled Case Manager to provide comprehensive case management services for members, assess needs, and develop care plans that promote quality and cost-effective outcomes.

This role focuses on coordinating services with care teams to ensure appropriate access and progress toward defined health goals. You will monitor member progress, advocate for patients, and ensure documentation aligns with HIPAA, policies, and accreditation standards while supporting a culture of

Qualifications

• 5 years in clinical, case/utilization management, or disease condition management or related health insurance operations.
• RN licensure in good standing; CCM certification within 36 months of hire (exemptions for incumbents hired before Aug 2026).
• Experience with diverse populations and a culture of competency in care delivery.

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 available resources.
• Develop individualized care plans with members, physicians, and providers.
• Implement and coordinate care plans, ensuring access to services and resources.
• Monitor progress and adjust care plans as needed.
• Evaluate interventions and advocate for cost-effective outcomes.
• Collaborate with physicians, providers, and team members to execute the care plan.
• Document activities in compliance with policies, HIPAA, and standards.
• Provide guidance and mentorship to lower-level Case Managers.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

MS Office & EHR

Education

High School/GED

Bachelor's in Nursing

Tools

Case management software

Electronic Health Records (EHR)

Job description

Highmark Inc. is seeking a skilled Case Manager to provide comprehensive case management services for members, assess needs, and develop care plans that promote quality and cost-effective outcomes.

This role focuses on coordinating services with care teams to ensure appropriate access and progress toward defined health goals. You will monitor member progress, advocate for patients, and ensure documentation aligns with HIPAA, policies, and accreditation standards while supporting a culture of