RN Case Manager: Care Coordination & Outcomes

Highmark Health; Salem (OR); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. in Salem, Oregon is seeking a skilled Case Manager to provide comprehensive case management services for members, coordinating care plans with physicians and other providers to ensure quality, cost-effective outcomes.

The role requires assessing needs, developing individualized care plans, coordinating referrals, monitoring progress, and documenting activities in HIPAA-compliant systems. A strong background in nursing and case management is preferred.

Qualifications

• 3 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience
• Current State of PA RN licensure OR current multi-state licensure through eNLC or WV/DE/NY; must be obtained within 6 months if applicable
• High School Diploma or GED required; Bachelor's Degree in Nursing preferred
• Experience with diverse populations and cultural competency is preferred
• Proficiency in Microsoft Office, case management software, and EHRs

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Develop and implement care plans with guidance from senior staff.
• Coordinate referrals to specialists and community resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Advocate and liaise to meet individual health care needs using resources to promote quality, cost-effective outcomes.
• Collaborate with physicians, providers, and health care team to carry out the plan of care.
• Document activities in compliance with policies and HIPAA/privacy rules.
• Identify opportunities for cost savings, quality improvement and workflow efficiency.
• Other duties as assigned.

Skills

Strong assessment and care planning

Independent and team work

Microsoft Office & EHR proficiency

Understanding of health care systems

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

Microsoft Office

Case management software

Job description

Highmark Inc. in Salem, Oregon is seeking a skilled Case Manager to provide comprehensive case management services for members, coordinating care plans with physicians and other providers to ensure quality, cost-effective outcomes.

The role requires assessing needs, developing individualized care plans, coordinating referrals, monitoring progress, and documenting activities in HIPAA-compliant systems. A strong background in nursing and case management is preferred.