Remote Senior RN Case Manager — Complex Care

Highmark Health; Minneota (MN); Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and implement care plans, and coordinate services to promote quality, cost-effective outcomes. The role involves collaboration with physicians, other providers, and the health care team while documenting activities in compliance with policies and HIPAA rules.

The position requires five years of related experience, RN licensure, and CCM certification within 36 months of hire,

Qualifications

• 5 years in clinical, case/utilization management, or health insurance experience.
• Experience with diverse populations in healthcare.
• Advanced CBT/MI/DBT training and experience.
• Clinical assessment and care planning expertise.
• Proficiency with MS Office, case management software and EHRs.
• Strong understanding of healthcare systems and case management principles.

Responsibilities

• 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.
• 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 with physicians, providers, and the health care team to carry out the plan of care.
• Ensure activities are documented per policies and regulatory requirements.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.

Skills

CBT

Motivational interviewing

DBT

Clinical assessment

Care coordination

Microsoft Office

Education

Bachelor's in Nursing

Tools

Microsoft Office

Electronic Health Records (EHR)

Care management software

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and implement care plans, and coordinate services to promote quality, cost-effective outcomes. The role involves collaboration with physicians, other providers, and the health care team while documenting activities in compliance with policies and HIPAA rules.

The position requires five years of related experience, RN licensure, and CCM certification within 36 months of hire,