RN Case Manager | Care Coordination & Advocacy

Highmark Health Company; Richmond (VA); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, coordinating care plans and resources to promote high-quality, cost-effective outcomes.

Responsibilities include assessing member needs, developing plans with providers, and monitoring progress while ensuring compliance with HIPAA and company policies. 3+ years of relevant experience and PA RN licensure or multi-state licensure are required or preferred.

Qualifications

• 3 years in clinical, case/utilization management, and/or disease condition management experience
• Current State of PA RN licensure or multi-state licensure via the Enhanced Nurse Licensure Compact (eNLC) or WV/DE/NY; must obtain within 6 months if applicable
• Bachelor's degree in Nursing preferred

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans with members, physicians, and other healthcare providers.
• Coordinate referrals to specialists and community resources.
• Monitor progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet a member's health care needs while ensuring compliance with contract benefits.

Skills

Assessment & care planning

Independent work

Team collaboration

EHR software proficiency

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

Microsoft Office

Case management software

Electronic health records (EHR)

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, coordinating care plans and resources to promote high-quality, cost-effective outcomes.

Responsibilities include assessing member needs, developing plans with providers, and monitoring progress while ensuring compliance with HIPAA and company policies. 3+ years of relevant experience and PA RN licensure or multi-state licensure are required or preferred.