RN Case Manager: Care Coordination & Outcomes

Highmark Health Company; Santa Fe (NM); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. seeks a Case Manager to provide comprehensive case management services, ensuring quality and cost-effective care. You will assess member needs, develop and implement care plans, coordinate services, and monitor progress while containing costs.

Responsibilities include managing a caseload, collaborating with physicians and providers, coordinating referrals, and documenting activities in accordance with HIPAA and company policies. 3 years of relevant experience is required.

Qualifications

• Strong assessment and care planning skills.
• Experience in case/utilization management or health insurance.
• Ability to work independently and as part of a team.
• Proficiency with Microsoft Office and EHRs.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess health status, needs and resources.
• Develop and implement individualized care plans with clinicians.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust plans as needed.
• Ensure documentation complies with policies and HIPAA.

Skills

Assessment

Care planning

Independent work

Microsoft Office suite

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

Case management software

Electronic Health Records

Job description

Highmark Inc. seeks a Case Manager to provide comprehensive case management services, ensuring quality and cost-effective care. You will assess member needs, develop and implement care plans, coordinate services, and monitor progress while containing costs.

Responsibilities include managing a caseload, collaborating with physicians and providers, coordinating referrals, and documenting activities in accordance with HIPAA and company policies. 3 years of relevant experience is required.