Remote Senior Oncology Case Manager RN

Highmark Health; Milton (MA); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a Case Manager to deliver comprehensive case management services, coordinating care plans and resources to promote optimal health outcomes while containing costs. The role requires exam and assessment of member needs, collaboration with physicians and care teams, and ongoing monitoring of progress.

Responsibilities include advocating for members, ensuring documentation compliance, and mentoring junior staff. Strong clinical background and CCM/RN credentials are valued.

Qualifications

• 5 years in clinical, case/utilization management, or health insurance experience.
• Current RN licensure or multi-state licensure via eNLC; CCM within 36 months of hire (exempt for Aug 2026 incumbents).
• Strong knowledge of care planning and clinical assessment.

Responsibilities

• Manage a caseload of members with complex health needs and advanced clinical requirements.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs, and available resources for members.
• Collaborate with members, physicians, and providers to implement care plans.
• Coordinate access to services and monitor progress toward goals.
• Evaluate interventions for effectiveness and adjust plans as needed.
• Provide guidance and mentorship to lower-level Case Managers.
• Document activities in compliance with policies and regulations.

Skills

Clinical assessment

Leadership

Advocacy

EHR proficiency

Healthcare systems

Education

High School/GED

Bachelors in Nursing

Tools

Microsoft Office

Case management software

Electronic health records

Job description

Highmark Health is seeking a Case Manager to deliver comprehensive case management services, coordinating care plans and resources to promote optimal health outcomes while containing costs. The role requires exam and assessment of member needs, collaboration with physicians and care teams, and ongoing monitoring of progress.

Responsibilities include advocating for members, ensuring documentation compliance, and mentoring junior staff. Strong clinical background and CCM/RN credentials are valued.