RN Case Manager: Care Coordination & Outcomes

Highmark Health; Augusta (ME); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services, focusing on cost-effective, quality care delivery. You will assess, plan, coordinate, and monitor care for members, partnering with physicians and providers to promote optimal health outcomes.

The role emphasizes adherence to HIPAA, documentation standards, and collaboration with the health care team to meet contract benefits. Travel up to 25% may be required.

Qualifications

• High School Diploma or GED required.
• Bachelor's Degree in Nursing preferred.
• 3 years of relevant clinical/case management or health insurance experience required.

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 providers.
• Coordinate care plans and ensure access to services and resources.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust care plans as needed.
• Evaluate interventions and advocate for member needs.

Skills

Assessment skills

Team collaboration

MS Office

Case management software

Electronic health records

Healthcare systems knowledge

Education

Bachelor's Degree in Nursing

High School Diploma/GED

Tools

Microsoft Office suite

Case management software

Electronic Health Records (EHR)

Job description

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services, focusing on cost-effective, quality care delivery. You will assess, plan, coordinate, and monitor care for members, partnering with physicians and providers to promote optimal health outcomes.

The role emphasizes adherence to HIPAA, documentation standards, and collaboration with the health care team to meet contract benefits. Travel up to 25% may be required.