Remote Senior RN Case Manager - Complex Care & Advocacy

Highmark Health; Washington (District of Columbia); Hybrid; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a Case Manager to deliver comprehensive case management services, coordinate care, and monitor outcomes while containing health care costs. The role includes assessing member needs, developing and implementing care plans, and advocating for members within contract benefits.

Collaboration with physicians and the health care team is essential to ensure quality, cost-effective outcomes.

Qualifications

• RN licensure in the applicable state.
• CCM certification within 36 months of hire.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans with members and providers.
• Coordinate and monitor access to services and resources.
• Monitor progress and adjust care plans as needed.
• Advocate and liaison to meet health care needs.
• Collaborate with physicians and care team to execute the plan.
• Ensure activities are documented per policies and standards.
• Provide guidance to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.

Skills

CBT

Motivational Interviewing

DBT

Clinical assessment

Care planning

Caseload management

EHR

Microsoft Office

Education

Bachelors in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records (EHR)

Job description

Highmark Health is seeking a Case Manager to deliver comprehensive case management services, coordinate care, and monitor outcomes while containing health care costs. The role includes assessing member needs, developing and implementing care plans, and advocating for members within contract benefits.

Collaboration with physicians and the health care team is essential to ensure quality, cost-effective outcomes.