Senior Case Manager RN: Complex Care & Advocacy (Remote)

Highmark Health; Montana; Hybrid; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and implement care plans, and coordinate services to ensure quality, cost-effective care.

The role requires 5 years of clinical or utilization management experience, RN licensure (state or eNLC), and CCM certification within 36 months. Proficiency with EHR and case management software is essential; collaboration with physicians and care teams is expected.

Qualifications

• 5 years in clinical, case/utilization management or health insurance experience.
• Experience with diverse populations and complex health needs.
• Advanced training in CBT, motivational interviewing or DBT.
• Proficiency with EHR and case management software; strong healthcare system knowledge.

Responsibilities

• Manage a caseload of members with complex health needs and develop care plans.
• Coordinate services, monitor progress, and adjust plans as needed.
• Advocate for members and liaise with physicians and providers.
• Document activities in compliance with policies and regulations.
• Provide mentorship to junior Case Managers.
• Collaborate with care teams to meet contractual benefits and quality goals.

Skills

CBT

Motivational interviewing

DBT

Care planning

Communication

Education

Bachelor's in Nursing

RN licensure (state)

CCM certification within 36 months

Multi-state license (eNLC)

Tools

Case management software

Electronic Health Records (EHR)

Microsoft Office

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and implement care plans, and coordinate services to ensure quality, cost-effective care.

The role requires 5 years of clinical or utilization management experience, RN licensure (state or eNLC), and CCM certification within 36 months. Proficiency with EHR and case management software is essential; collaboration with physicians and care teams is expected.