RN Case Manager: Care Coordination & Outcomes

Highmark Health Company; Hartford (CT); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor outcomes.

The role emphasizes cost-effective care delivery and advocacy for members’ health needs within contract benefits. The position requires RN licensure (PA or multi-state via eNLC/DE/WV/NY) and at least 3 years in clinical or utilization management, with strong teamwork and proficiency in EHR systems.

Qualifications

• High School Diploma or GED required.
• Bachelor's Degree in Nursing preferred.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust care plans as needed.
• Ensure activities are documented per policies and HIPAA requirements.

Skills

Assessment

Care planning

Independent work

Team collaboration

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

Microsoft Office

Electronic Health Records

Case management software

Job description

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor outcomes.

The role emphasizes cost-effective care delivery and advocacy for members’ health needs within contract benefits. The position requires RN licensure (PA or multi-state via eNLC/DE/WV/NY) and at least 3 years in clinical or utilization management, with strong teamwork and proficiency in EHR systems.