RN Case Manager - Care Coordination & Cost Management

Highmark Health Company; Bismarck (ND); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, assess member needs, and coordinate care to promote optimal health outcomes. You will work with physicians and providers to develop and implement tailored care plans while monitoring progress and containing costs.

Required licensure and several years of related experience; Bachelor’s in Nursing preferred, with strong assessment and documentation skills. Office-based role with moderate travel in the region.

Qualifications

• High School Diploma or GED required; BSN preferred; licensure required as noted.
• 3 years in clinical, case/utilization management, or related health-insurance roles.
• Proficiency with Microsoft Office, case management software, and EHR systems.
• Strong understanding of care coordination and resource navigation.

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 providers.
• Implement and coordinate care plans, ensuring access to services and resources.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust care plans as needed.
• Advocate for members to ensure cost-effective, quality outcomes within contract benefits.

Skills

Assessment skills

Care planning

Independent work

Team collaboration

EHR 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, assess member needs, and coordinate care to promote optimal health outcomes. You will work with physicians and providers to develop and implement tailored care plans while monitoring progress and containing costs.

Required licensure and several years of related experience; Bachelor’s in Nursing preferred, with strong assessment and documentation skills. Office-based role with moderate travel in the region.