RN Case Manager: Elevate Coordinated, Cost-Effective Care

Highmark Health; Cheyenne (WY); Remote; USD 73,000 - 117,000; Full time

Job summary

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

You will work with physicians and the health care team to ensure access to services and resources in a compliant, patient-centered approach. The role requires strong assessment and care planning skills, independence, teamwork, and proficiency with EHRs and case management software.

Qualifications

• High School Diploma/GED (Required).
• Bachelor's Degree in Nursing (Preferred).
• Current PA RN licensure or multi-state licensure via eNLC or WV/DE/NY; within 6 months if not already licensed.
• 3 years in clinical, case/utilization management, or health insurance experience.

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 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.
• Advocate and liaise to meet member health care needs using available resources.
• Work collaboratively with physicians and care teams; document activities per policy.
• Identify areas for potential cost savings, quality improvement and workflow efficiencies.
• Other duties as assigned or requested.

Skills

Assessment skills

Care planning

Independence

Teamwork

Microsoft Office

Case management software

Electronic health records

Healthcare systems knowledge

Education

High School Diploma/GED

Bachelor's Degree in Nursing

RN licensure (PA or eNLC or WV/DE/NY) within 6 months

3 years clinical/case/utilization management or health insurance experience

Job description

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

You will work with physicians and the health care team to ensure access to services and resources in a compliant, patient-centered approach. The role requires strong assessment and care planning skills, independence, teamwork, and proficiency with EHRs and case management software.