RN Case Manager: Care Navigator & Outcomes Advocate

Highmark Health; Boise (ID); A distancia; USD 73.000 - 117.000; Jornada completa

Descripción de la vacante

Highmark Health seeks a Case Manager to provide comprehensive case management services for members, promoting quality and cost-effective care. You will assess needs, develop and coordinate care plans, and monitor progress across care teams.

The role emphasizes collaboration with physicians and providers, documentation compliance, and ongoing evaluation of interventions to achieve optimal health outcomes while controlling costs.

Formación

• Must have active RN licensure (PA or multi-state via eNLC or equivalent) and be eligible within 6 months of hire.
• Demonstrated 3 years of related clinical or utilization management experience or health insurance industry experience.

Responsabilidades

• 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.
• Act as an advocate and liaison to meet a member's individual healthcare needs.
• Work collaboratively with physicians, providers, and the health care team to execute the plan of care.
• Ensure all activities are documented in compliance with policies and regulations.
• Identify areas for potential cost savings, quality improvement, and workflow efficiencies.
• Other duties as assigned.

Conocimientos

Care planning

Independent work

Team collaboration

EHR software knowledge

Educación

High School Diploma/GED

Bachelor's Degree in Nursing

Herramientas

Microsoft Office Suite

Case management software

Electronic Health Records

Descripción del empleo

Highmark Health seeks a Case Manager to provide comprehensive case management services for members, promoting quality and cost-effective care. You will assess needs, develop and coordinate care plans, and monitor progress across care teams.

The role emphasizes collaboration with physicians and providers, documentation compliance, and ongoing evaluation of interventions to achieve optimal health outcomes while controlling costs.