RN Case Manager | Coordinated Care & Outcomes

Highmark Health; Northern (KY); Hybrid; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management for members, assessing needs, developing and coordinating care plans, and monitoring progress to ensure quality outcomes while containing costs.

The role requires an RN license, 3 years in case/ utilization management, and strong skills in assessment, care planning, and collaboration with physicians, providers, and health teams. Travel is 0%–25%.

Qualifications

• High School Diploma or GED required.
• Bachelor's Degree in Nursing preferred.
• 3 years of clinical/case management experience required.
• RN licensure current in PA or multi-state eNLC/other states within 6 months.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess health status, needs, and resources.
• Develop individualized care plans with members and providers.
• Coordinate referrals and services across care continuum.
• Monitor progress and adjust care plans as needed.
• Ensure documentation complies with HIPAA and policies.
• Identify opportunities for cost savings and quality improvement.

Skills

Assessment skills

Care planning

Independent / team work

MS Office / EHR

Healthcare systems 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. is seeking a Case Manager to deliver comprehensive case management for members, assessing needs, developing and coordinating care plans, and monitoring progress to ensure quality outcomes while containing costs.

The role requires an RN license, 3 years in case/ utilization management, and strong skills in assessment, care planning, and collaboration with physicians, providers, and health teams. Travel is 0%–25%.