RN Case Manager: Care Coordination Leader

Highmark Health; Montpelier (VT); 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 plans to promote quality, cost-effective outcomes.

You will work with physicians and providers to ensure access to services, monitor progress, and contain healthcare costs while complying with HIPAA and privacy policies. The role requires RN licensure (PA or multi-state/ eNLC) with 3 years of relevant experience, strong assessment and care planning skills, and

Qualifications

• 3 years in clinical, case/utilization management, disease condition management or health insurance operations.
• Experience with diverse populations and cultural competency is preferred.
• RN licensure in PA or multi-state eNLC/WV/DE/NY, or eligible to obtain within 6 months.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess health status, needs, and available resources.
• Develop individualized care plans with members and providers.
• Coordinate care plans and ensure access to services.
• Monitor progress and adjust plans as needed.
• Advocate for members and communicate with the care team.

Skills

Care planning

Assessment

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 plans to promote quality, cost-effective outcomes.

You will work with physicians and providers to ensure access to services, monitor progress, and contain healthcare costs while complying with HIPAA and privacy policies. The role requires RN licensure (PA or multi-state/ eNLC) with 3 years of relevant experience, strong assessment and care planning skills, and