Remote Senior RN Case Manager - Complex Care & Advocacy

Highmark Health

Olympia (WA)

Hybrid

USD 79,000 - 127,000

Full time

5 days ago

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Job summary

Highmark Health is seeking a Case Manager to deliver comprehensive case management services for members, coordinating care plans with physicians and providers to ensure quality and cost-effective outcomes.

The role requires expert clinical assessment, leadership, and strong proficiency with EHRs and case management software. Collaboration with the care team ensures plans are implemented and outcomes are monitored.

Travel is limited to less than 25% to support member care coordination.

Qualifications

RN licensure active in the state or multi-state via eNLC.
CCM certification must be obtained within 36 months of hire; incumbents as of Aug 2026 are exempt.
5 years in clinical, case/utilization management, or health insurance operations.
Preferred: transplant clinical experience.

Responsibilities

Manage a caseload of members with complex health needs and advanced clinical knowledge.
Conduct comprehensive assessments and develop complex care plans.
Assess health status, needs, and available resources.
Coordinate care plans with members, physicians, and providers.
Monitor progress and adjust plans to meet goals.
Advocate and liaise to meet patients' health care needs.
Document activities in compliance with policies and standards.
Mentor lower-level Case Managers and provide clinical guidance.