Remote Senior RN Case Manager - Care & Cost Advocate

Highmark Health Company; Honolulu (HI); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor progress to promote quality, cost-effective outcomes.

The role supports collaboration with physicians and healthcare providers, ensuring compliant documentation and mentorship to junior staff while containing costs as part of the member benefits.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management experience.
• RN licensure with CCM certification must be obtained within 36 months of hire

Responsibilities

• Manage a caseload of members with complex health needs.
• 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.
• Advocate and liaise to address member health care needs and ensure cost-effective outcomes.
• Collaborate with physicians, providers, and the health care team to carry out the plan of care.
• Document activities per policies and standards.

Skills

Clinical assessment

Care planning

Leadership

EHR proficiency

Healthcare systems knowledge

Education

High School/GED

Bachelor's in Nursing

Tools

Case management software

Microsoft Office

Electronic Health Records

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor progress to promote quality, cost-effective outcomes.

The role supports collaboration with physicians and healthcare providers, ensuring compliant documentation and mentorship to junior staff while containing costs as part of the member benefits.