RN Case Manager: Care Planner & Advocate

Highmark Health; Madison (WI); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, develop care plans, coordinate services, and monitor outcomes to promote quality and cost-effective care.

The role requires a State RN license or multi-state licensure, 3+ years of relevant experience, and strong collaboration with physicians and health care teams. Office-based position with travel up to 25% and focus on compliant, patient-centered care.

Qualifications

• 3 years in clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience
• Experience with diverse populations and cultural competency preferred
• HIPAA compliance and accurate documentation are essential

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.
• 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 health care needs while promoting quality, cost-effective outcomes.

Skills

Assessment & care planning

Independent / team work

Microsoft Office & EHR

Healthcare systems knowledge

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

Microsoft Office

Electronic Health Records (EHR)

Case Management Software

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, develop care plans, coordinate services, and monitor outcomes to promote quality and cost-effective care.

The role requires a State RN license or multi-state licensure, 3+ years of relevant experience, and strong collaboration with physicians and health care teams. Office-based position with travel up to 25% and focus on compliant, patient-centered care.