Senior Case Manager RN — Complex Care

IntelliResume; Pennsylvania; Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a Senior Case Manager RN to provide comprehensive case management for members with complex health needs. You will lead assessments, develop and implement individualized care plans, and coordinate services across a multidisciplinary team.

The role emphasizes strong clinical knowledge and leadership, with responsibilities including monitoring progress, advocacy, and ensuring documentation meets regulatory requirements.

Qualifications

• High School/GED required.
• Bachelor’s in Nursing preferred.
• 5 years in clinical, case/utilization management, and/or disease condition management experience required.
• Specialty specific clinical experience preferred.
• Current State RN licensure or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) required.
• Certified Case Manager (CCM) certification must be obtained within 36 months of hire.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet a member's individual health care needs.
• Work collaboratively and communicate clearly with healthcare team members.
• Ensure all activities are documented in compliance with applicable requirements.

Skills

Clinical knowledge

Leadership

Communication

Education

High School/GED

Bachelor's in Nursing

Job description

Highmark Health is seeking a Senior Case Manager RN to provide comprehensive case management for members with complex health needs. You will lead assessments, develop and implement individualized care plans, and coordinate services across a multidisciplinary team.

The role emphasizes strong clinical knowledge and leadership, with responsibilities including monitoring progress, advocacy, and ensuring documentation meets regulatory requirements.