RN Case Manager: Care Coordination & Outcomes

Highmark Health Company; Phoenix (AZ); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services to members, developing and coordinating care plans to promote optimal health outcomes and cost-effective care delivery.

You will assess member needs, collaborate with physicians and providers, monitor progress, and ensure care plans are implemented while containing costs. This role emphasizes advocacy, documentation, and professional collaboration within established policies.

Qualifications

• 3 years in clinical, case/utilization management, and/or disease condition management or related health-insurance experience.
• RN licensure: PA license or multi-state licensure via eNLC or equivalent, required within 6 months.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and resources.
• Develop individualized care plans with members, physicians, and providers.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust care plans as needed.
• Document activities per HIPAA, policies, and standards.
• Advocate for members to ensure cost-effective, quality care.

Skills

Case management skills

Care planning

Independent work

Microsoft Office

Case management software

Electronic health records

Healthcare system knowledge

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

Microsoft Suite

Case management software

Electronic Health Records (EHR)

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services to members, developing and coordinating care plans to promote optimal health outcomes and cost-effective care delivery.

You will assess member needs, collaborate with physicians and providers, monitor progress, and ensure care plans are implemented while containing costs. This role emphasizes advocacy, documentation, and professional collaboration within established policies.