Remote Senior RN Case Manager: Complex Care & Advocacy

Highmark Health; Little Rock (AR); Hybride; USD 79 000 - 127 000; Plein temps

Résumé du poste

Highmark Health in the United States is seeking a Case Manager to deliver comprehensive case management services for members, aiming for quality and cost-effective care. The role involves assessing needs, creating care plans, coordinating services, and monitoring outcomes in collaboration with clinicians and providers.

Responsibilities include managing a caseload of patients with complex health needs, advocating for members, and ensuring adherence to regulatory and contractual requirements.

Qualifications

• Current State RN licensure or multi-state licensure via eNLC.
• Certified Case Manager (CCM) certification must be obtained within 36 months of hire.
• Preferred: certification in clinical area (e.g., OCN, CPN, CPON, CNN, CCTC, CPHQ).

Responsabilités

• Manage a caseload of members with complex health needs.
• Develop individualized care plans in collaboration with members, physicians, and providers.
• Coordinate services and monitor progress toward goals.
• Advocate and liaison to meet members' health care needs.
• Ensure documentation complies with HIPAA and company policies.

Connaissances

Clinical assessment

Care planning

Leadership

Negotiation

EHR / case mgmt software

Formation

High School/GED

Bachelor in Nursing

Outils

Case management software

Microsoft Office

Electronic Health Records (EHR)

Description du poste

Highmark Health in the United States is seeking a Case Manager to deliver comprehensive case management services for members, aiming for quality and cost-effective care. The role involves assessing needs, creating care plans, coordinating services, and monitoring outcomes in collaboration with clinicians and providers.

Responsibilities include managing a caseload of patients with complex health needs, advocating for members, and ensuring adherence to regulatory and contractual requirements.