Remote Senior RN Case Manager: Complex Care & Advocacy

Highmark Health; Montgomery (AL); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. seeks an experienced Case Manager to provide comprehensive case management services, assess needs, develop and coordinate complex care plans, and monitor outcomes while containing costs.

You will act as an advocate, collaborate with physicians and the care team, and ensure documentation complies with HIPAA and policy standards. Required RN licensure (state or multi-state via eNLC) and 5 years of related experience; CCM certification must be obtained within 36 months of hire.

Qualifications

• 5 years in clinical, case/utilization management, or disease condition management.
• Current RN licensure or multi-state licensure via eNLC.
• CCM certification must be obtained within 36 months of hire; Aug 2026 incumbents exempt.
• Preferred transplant-specific experience and cultural competency knowledge.

Responsibilities

• Manage a caseload of members with complex health needs and coordinate services.
• Perform comprehensive assessments and develop complex care plans.
• Collaborate with members, physicians and providers to implement plans.
• Monitor progress and adjust care plans to achieve outcomes.
• Advocate for patients and ensure compliance with policies and HIPAA.
• Document activities accurately and mentor junior Case Managers.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

EHR proficiency

Education

High School/GED

Bachelor's in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records

Job description

Highmark Inc. seeks an experienced Case Manager to provide comprehensive case management services, assess needs, develop and coordinate complex care plans, and monitor outcomes while containing costs.

You will act as an advocate, collaborate with physicians and the care team, and ensure documentation complies with HIPAA and policy standards. Required RN licensure (state or multi-state via eNLC) and 5 years of related experience; CCM certification must be obtained within 36 months of hire.