RN Case Manager: Care Coordination & Outcomes

Highmark Health; Topeka (KS); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. in Topeka, KS seeks a Case Manager to provide comprehensive case management services, promoting quality and cost-effective care while coordinating care plans with physicians and providers.

The role requires assessing member needs, developing care plans, monitoring progress, ensuring access to services, and documenting activities in compliance with HIPAA and company policies.

Qualifications

• 3 years in clinical, case/utilization management, or disease condition management experience, or provider operations/health insurance experience.
• Experience with diverse populations is preferred.
• Current RN licensure in PA or multi-state licensure via eNLC or WV/DE/NY within 6 months.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans with members, physicians, and other providers.
• Implement and coordinate care plans, ensuring access to services and resources.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust care plans as needed.

Skills

Caseload management

Care planning

MS Office

EHR systems

Healthcare knowledge

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records (EHR)

Job description

Highmark Inc. in Topeka, KS seeks a Case Manager to provide comprehensive case management services, promoting quality and cost-effective care while coordinating care plans with physicians and providers.

The role requires assessing member needs, developing care plans, monitoring progress, ensuring access to services, and documenting activities in compliance with HIPAA and company policies.