RN Case Manager: Care Coordination & Advocacy

Highmark Health; Trenton (NJ); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. in New Jersey is seeking an experienced Case Manager to provide comprehensive care coordination for members, assess needs, develop and monitor individualized care plans, and promote quality, cost-effective health outcomes.

This role requires 3 years in clinical or utilization management, an active RN license, and the ability to work with diverse populations. Travel up to 25% and a office-based setting are expected. Documentation and HIPAA compliance are essential.

Qualifications

• 3 years in clinical, case/utilization management or disease management roles.
• Active RN license in PA or multi-state with eNLC; must obtain within 6 months if applicable.
• High school diploma required; bachelor's degree preferred in nursing.
• Experience with diverse populations and cultural competency preferred.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members' health status, needs and resources.
• Develop individualized care plans with members, physicians and providers.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust care plans as needed.
• Document activities in compliance with HIPAA and policies.

Skills

Assessment & care planning

Independent work

EHR software

Healthcare systems

Education

High School Diploma/GED

Bachelor's degree in Nursing

Tools

Microsoft Office

Case management software

EMR/EHR systems

Job description

Highmark Inc. in New Jersey is seeking an experienced Case Manager to provide comprehensive care coordination for members, assess needs, develop and monitor individualized care plans, and promote quality, cost-effective health outcomes.

This role requires 3 years in clinical or utilization management, an active RN license, and the ability to work with diverse populations. Travel up to 25% and a office-based setting are expected. Documentation and HIPAA compliance are essential.