RN Case Manager: Care Coordination & Advocacy

Highmark Health Company; Atlanta (GA); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking an experienced Case Manager to provide comprehensive case management services, coordinating care plans and advocating for members to ensure quality and cost-effective outcomes. You will assess needs, develop plans with providers, and monitor progress within HIPAA guidelines.

The role requires an RN license (PA, multi-state via eNLC, or equivalent) and 3 years of related experience, with a preference for Nursing degree holders and experience across diverse populations.

Qualifications

• Required: High School Diploma or GED.
• Preferred: Bachelor's Degree in Nursing.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Develop and implement care plans with guidance from senior staff.
• Coordinate referrals to specialists and community resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Advocate for members to meet health care needs within contract benefits.

Skills

Assessment skills

Care planning

Team player

MS Office / EHR

Healthcare systems knowledge

Education

High School Diploma/GED

Bachelor's in Nursing

Tools

Case management software

Electronic Health Records

Microsoft Office

Job description

Highmark Inc. is seeking an experienced Case Manager to provide comprehensive case management services, coordinating care plans and advocating for members to ensure quality and cost-effective outcomes. You will assess needs, develop plans with providers, and monitor progress within HIPAA guidelines.

The role requires an RN license (PA, multi-state via eNLC, or equivalent) and 3 years of related experience, with a preference for Nursing degree holders and experience across diverse populations.