RN Case Manager: Care Navigator & Advocate

Highmark Health; Carson City (NV); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services, assess member needs, and develop and coordinate care plans with physicians and other health professionals to promote optimal outcomes.

The role emphasizes monitoring progress, ensuring access to services, and advocating for members while containing health care costs within contract benefits. HIPAA compliance and professional teamwork are essential.

Qualifications

• 3 years in clinical, case/utilization management, and/or disease condition management experience.
• Experience with diverse populations and cultural competency preferred.
• Proficiency with Microsoft Office, case management software, and electronic health records.

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.

Skills

Assessment

Care planning

Team collaboration

Healthcare systems understanding

Education

High School Diploma/GED

Bachelor’s Degree in Nursing

Tools

Microsoft Office

Case management software

Electronic health records

Job description

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services, assess member needs, and develop and coordinate care plans with physicians and other health professionals to promote optimal outcomes.

The role emphasizes monitoring progress, ensuring access to services, and advocating for members while containing health care costs within contract benefits. HIPAA compliance and professional teamwork are essential.