RN Case Manager: Care Planner & Advocate

Santa Barbara Cottage Hospital; United States; Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services. You will assess member needs, develop and implement care plans, coordinate services, and monitor progress while containing health care costs.

The role supports collaboration with physicians and health teams, ensuring compliance with regulatory standards and contract benefits. Strong documentation and communication are essential.

Qualifications

• High School Diploma or GED is required.
• Bachelor's Degree in Nursing is preferred.
• 3 years in clinical, case/utilization management, disease condition management, or health-insurance roles.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and resources.
• Develop individualized care plans with members, physicians, and other providers.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust care plans as needed.
• Document activities in compliance with policies, HIPAA and regulations.
• Identify opportunities for cost savings, quality improvement and workflow efficiencies.
• Collaborate with physicians, providers, and health care team to carry out the plan.

Skills

Assessment skills

Care planning

Teamwork

MS Office & EHR

Case management

Healthcare systems

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 provide comprehensive case management services. You will assess member needs, develop and implement care plans, coordinate services, and monitor progress while containing health care costs.

The role supports collaboration with physicians and health teams, ensuring compliance with regulatory standards and contract benefits. Strong documentation and communication are essential.