Remote Senior RN Case Manager – Care Coordination

Highmark Health; Lorida (FL); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking an experienced Case Manager to provide comprehensive care coordination for members with complex health needs. You will assess needs, develop care plans, coordinate services, and monitor progress while containing healthcare costs.

This role requires strong clinical knowledge, HIPAA compliance, and collaboration with physicians and providers. Office-based or remote, with travel under 25%, and opportunities to mentor junior staff.

Qualifications

• 5 years in case management, utilization management, or related health services.
• Experience with diverse patient populations preferred.
• Strong knowledge of HIPAA and compliance standards.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop care plans.
• Coordinate services and monitor progress toward goals.
• Collaborate with physicians and providers to implement plans.
• Ensure documentation meets policy and regulatory standards.
• Mentor lower-level case managers and act as resource.
• Advocate for members to access appropriate services.

Skills

Clinical assessment

Care planning

Leadership & mentoring

Documentation & compliance

EHR proficiency

Education

High School/GED

Bachelor's in Nursing

Tools

Case management software

Microsoft Office

Electronic Health Records (EHR)

Job description

Highmark Inc. is seeking an experienced Case Manager to provide comprehensive care coordination for members with complex health needs. You will assess needs, develop care plans, coordinate services, and monitor progress while containing healthcare costs.

This role requires strong clinical knowledge, HIPAA compliance, and collaboration with physicians and providers. Office-based or remote, with travel under 25%, and opportunities to mentor junior staff.