Remote Senior Case Manager RN - Complex Care Leader

Highmark Health; New Mexico; Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services to members, ensuring quality and cost-effective care outcomes. The role includes assessing needs, developing care plans, coordinating services, and monitoring progress while containing health care costs.

The ideal candidate will handle complex cases, collaborate with physicians and providers, and mentor junior staff. Compliance with HIPAA, policies, and accreditation standards is required.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management experience.
• Preferred transplant-specific clinical experience.
• 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 individualized care plans in collaboration with members and providers.
• Coordinate services and monitor progress toward goals.
• Advocate for members and ensure cost-effective care within contract benefits.
• Document activities in compliance with policies and standards.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

Microsoft Office

Electronic health records

Education

High School/GED

Bachelor's in Nursing

Tools

Case management software

Electronic health records

Job description

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services to members, ensuring quality and cost-effective care outcomes. The role includes assessing needs, developing care plans, coordinating services, and monitoring progress while containing health care costs.

The ideal candidate will handle complex cases, collaborate with physicians and providers, and mentor junior staff. Compliance with HIPAA, policies, and accreditation standards is required.