Remote Transplant Case Manager RN

Highmark Health; Austin (TX); Hybrid; USD 86,000 - 139,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive transplant case management for members, focusing on quality, cost-effective care and optimal health outcomes.

You will assess needs, develop and implement care plans, coordinate services, and monitor progress while containing healthcare costs. The role requires extensive clinical/case management experience, RN licensure, and CCM certification within 36 months of hire.

Qualifications

• 7 years of experience in clinical, case/utilization management, disease condition management, or related health insurance operations.
• Transplant experience preferred.
• Experience with diverse populations and cultural competency.
• Advanced training in CBT, motivational interviewing, or DBT is a plus.

Responsibilities

• Provide case management to members with complex or specialized needs (e.g., transplant, oncology, pediatrics).
• Oversee a panel of members, assess health needs, and triage to resources.
• Develop and implement strategies to improve outcomes and reduce costs for specialized populations.
• Coordinate care plans and ensure access to services and resources.
• Monitor progress, adjust plans, and evaluate intervention effectiveness.
• Act as liaison with physicians and care teams to execute the plan of care.
• Document activities compliant with policies and standards.

Skills

Transplant care

Analytical skills

Communication skills

Data interpretation

Generative AI

Education

Bachelor’s degree in Nursing

Tools

Microsoft Office

Case management software

Electronic health records

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive transplant case management for members, focusing on quality, cost-effective care and optimal health outcomes.

You will assess needs, develop and implement care plans, coordinate services, and monitor progress while containing healthcare costs. The role requires extensive clinical/case management experience, RN licensure, and CCM certification within 36 months of hire.