RN Case Manager: Care Coordination & Cost Control

Highmark Health; Dover (DE); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. seeks a Case Manager to provide comprehensive case management services to members, assessing needs, developing care plans, coordinating services, and monitoring progress to promote quality and cost-effective care.

You will work with physicians and other providers, document activities in accordance with policies, and identify opportunities for cost savings and process improvements while adhering to HIPAA and privacy standards.

Qualifications

• Required RN licensure in PA or multi-state licensure including DE/WV/NY/others.
• Minimum 3 years in clinical, case/utilization management or health insurance roles.
• Experience with diverse populations and cultural competency is preferred.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess health status, needs and resources; develop individualized care plans.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust plans to meet goals; document activities.

Skills

Assessment skills

Care planning

Independent work

MS Office

EMR systems

Healthcare systems knowledge

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Job description

Highmark Inc. seeks a Case Manager to provide comprehensive case management services to members, assessing needs, developing care plans, coordinating services, and monitoring progress to promote quality and cost-effective care.

You will work with physicians and other providers, document activities in accordance with policies, and identify opportunities for cost savings and process improvements while adhering to HIPAA and privacy standards.