Remote Senior RN Case Manager – Complex Care & Advocacy

Highmark Health; Kentucky; À distance; USD 79 000 - 127 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services for members, aiming to deliver high-quality, cost-effective care and improve health outcomes.

The role includes assessing needs, developing care plans, coordinating services, and monitoring progress while containing healthcare costs. The position requires extensive clinical knowledge, collaboration with physicians, and mentorship to junior staff.

Qualifications

• Experience in case management, utilization management, or disease condition management.
• Strong collaboration with physicians and other healthcare providers.
• Ability to document activities in compliance with policies and regulatory standards.

Responsabilités

• Manage a caseload of members with complex health needs.
• Develop and implement individualized care plans with members and providers.
• Coordinate services to ensure access to care and resources.
• Monitor progress and adjust plans to achieve goals.
• Act as advocate and liaison to optimize member outcomes.

Connaissances

Clinical assessment

Care planning

Leadership

Negotiation

Advocacy

EHR systems

Healthcare knowledge

Formation

High School/GED

Bachelor's in Nursing

RN licensure or eNLC

CCM certification (within 36 months)

Description du poste

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services for members, aiming to deliver high-quality, cost-effective care and improve health outcomes.

The role includes assessing needs, developing care plans, coordinating services, and monitoring progress while containing healthcare costs. The position requires extensive clinical knowledge, collaboration with physicians, and mentorship to junior staff.