Remote Senior Case Manager RN: Complex Care & Outcomes

Highmark Health; Nashville (TN); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a dedicated Case Manager to deliver comprehensive case management for members with complex health needs. The role focuses on creating and coordinating care plans, ensuring access to services, and monitoring outcomes to promote quality and cost-effective care.

The position requires strong clinical assessment, care planning, and collaboration with physicians and the health care team. Travel is minimal and compliance with HIPAA and company policies is mandatory.

Qualifications

• Current State RN licensure or multi-state licensure (eNLC)
• CCM certification must be obtained within 36 months of hire (exempt from this requirement for incumbents as of Aug 2026)
• Bachelor's degree in Nursing or higher preferred

Responsibilities

• Manage a caseload of members with complex health needs and develop care plans.
• Coordinate services and monitor progress toward goals.
• Advocate for member needs and liaise with physicians and providers.
• Document activities in compliance with HIPAA and company policies.
• Mentor lower-level Case Managers and share clinical expertise.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

EMR / Case management software

Healthcare systems knowledge

Education

RN licensure (state or eNLC)

Bachelor of Science in Nursing

Tools

Case management software

Electronic Health Records (EHR)

Microsoft Office

Job description

Highmark Inc. is seeking a dedicated Case Manager to deliver comprehensive case management for members with complex health needs. The role focuses on creating and coordinating care plans, ensuring access to services, and monitoring outcomes to promote quality and cost-effective care.

The position requires strong clinical assessment, care planning, and collaboration with physicians and the health care team. Travel is minimal and compliance with HIPAA and company policies is mandatory.