RN Case Manager: Expert Care Coordination & Advocacy

Highmark Health; Juneau (AK); Remote; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. in the United States seeks a Case Manager to provide comprehensive case management for members, coordinating care and developing care plans while containing costs. You will assess needs, collaborate with physicians and providers, and monitor progress to ensure quality outcomes.

Required is an RN license (PA or multi-state via eNLC or equivalent) and 3 years of related experience. A High School Diploma/GED is required; a Bachelor's in Nursing is preferred. Travel 0–25%.

Qualifications

• Requires RN licensure (PA or multi-state via eNLC or equivalent)
• 3 years of clinical/case management or related health-insurance experience
• Bachelor's degree in Nursing preferred
• Excellent communication and collaboration with care teams
• Knowledge of HIPAA and data privacy requirements

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 providers.
• Coordinate referrals to specialists and community resources.
• Monitor progress and adjust care plans as needed.
• Ensure documentation complies with policies and regulations.

Skills

Assessment & care planning

Independence

MS Office & EHR

Healthcare systems knowledge

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

Microsoft Office Suite

Case management software

Electronic Health Records (EHR)

Job description

Highmark Inc. in the United States seeks a Case Manager to provide comprehensive case management for members, coordinating care and developing care plans while containing costs. You will assess needs, collaborate with physicians and providers, and monitor progress to ensure quality outcomes.

Required is an RN license (PA or multi-state via eNLC or equivalent) and 3 years of related experience. A High School Diploma/GED is required; a Bachelor's in Nursing is preferred. Travel 0–25%.