RN Case Manager: Coordinated Care & Outcomes

Highmark Health; Salem (OR); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Health is seeking a dedicated Case Manager to provide comprehensive case management services to members, promoting quality and cost-effective care delivery. You will assess member needs, develop and implement individualized care plans, coordinate services with physicians and providers, and monitor progress to ensure optimal health outcomes while containing costs.

You will work in an office setting and follow HIPAA and company policies.

Qualifications

• 3 years in clinical, case/utilization management, and/or health insurance roles.
• Current State RN licensure in PA and multi-state licensure (eNLC) or applicable states, to be obtained within 6 months.
• Nursing degree preferred.

Responsibilities

• Manage a caseload of members with moderate complexity health needs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to services and resources.
• Develop and implement care plans with guidance from senior staff.
• Coordinate referrals to specialists and community resources.
• Monitor progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Advocate for members by coordinating options within contract benefits and resources.
• Collaborate with physicians, providers, and team to execute the plan of care.
• Ensure activities comply with business processes, policies, regulatory requirements, and accreditation standards.
• Identify areas for potential cost savings, quality improvement and workflow efficiencies.
• Other duties as assigned or requested.

Skills

Assessment

Care planning

Independent work

Team collaboration

EHR proficiency

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records

Job description

Highmark Health is seeking a dedicated Case Manager to provide comprehensive case management services to members, promoting quality and cost-effective care delivery. You will assess member needs, develop and implement individualized care plans, coordinate services with physicians and providers, and monitor progress to ensure optimal health outcomes while containing costs.

You will work in an office setting and follow HIPAA and company policies.