RN Case Manager: Care Coordination & Outcomes

Highmark Health; Honolulu (HI); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, ensuring quality, cost-effective care and optimal health outcomes for members.

The role involves assessing needs, developing and coordinating care plans, and monitoring progress while containing costs. The position requires careful advocacy and collaboration with physicians and providers, ensuring documentation adheres to HIPAA and company policies.

Qualifications

• High School Diploma or GED is required.
• Bachelor's Degree in Nursing is preferred.
• Experience with case management software and EHR is desired.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess health status, needs and resources of members.
• Develop individualized care plans with members and providers.
• Implement and coordinate care plans ensuring access to services.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust plans as needed.
• Document activities per policies and regulatory standards.

Skills

Care plan development

Independent & team work

MS Office & EHR software

Healthcare system understanding

Education

High School Diploma/GED

Bachelor's in Nursing (preferred)

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, ensuring quality, cost-effective care and optimal health outcomes for members.

The role involves assessing needs, developing and coordinating care plans, and monitoring progress while containing costs. The position requires careful advocacy and collaboration with physicians and providers, ensuring documentation adheres to HIPAA and company policies.