Remote Senior RN Case Manager: Care Coordination Leader

Highmark Health; New York (NY); Hybride; USD 79 000 - 127 000; Plein temps

Résumé du poste

Highmark Health is seeking a Case Manager to provide comprehensive case management services, coordinating care plans to achieve quality, cost-effective outcomes. The role focuses on assessing member needs, developing and implementing plans, and monitoring progress while containing healthcare costs.

The incumbent will collaborate with physicians and healthcare teams, ensure documentation compliance, and mentor junior staff.

Qualifications

• 5 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.
• Transplant specific clinical experience
• Experience working with the healthcare needs of diverse populations
• Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT)

Responsabilités

• 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 in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services.
• Work collaboratively and communicate clearly and professionally with physicians, providers, co-workers and other members of the health care team to carry out the established plan of care.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements, company policies, regulatory requirements and accreditation standards.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.
• Other duties as assigned or requested.

Connaissances

Clinical assessment

Care planning

Leadership & mentoring

Negotiation & advocacy

Microsoft Office

Case management software

Electronic health records

Healthcare systems

Formation

High School/GED

Bachelor's in Nursing

Description du poste

Highmark Health is seeking a Case Manager to provide comprehensive case management services, coordinating care plans to achieve quality, cost-effective outcomes. The role focuses on assessing member needs, developing and implementing plans, and monitoring progress while containing healthcare costs.

The incumbent will collaborate with physicians and healthcare teams, ensure documentation compliance, and mentor junior staff.