Senior Case Manager RN - Oncology (Remote)

Highmark Health; Pennsylvania; Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services to members, coordinating care plans with physicians and healthcare providers to promote high-quality, cost-effective outcomes.

The role requires 5+ years in clinical or utilization management, RN licensure, and CCM certification within 36 months; oncology exposure and cultural competency are preferred. The position can be office-based or remote, with less than 25% travel.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management experience.
• Preferred oncology specialty clinical experience.
• Experience with diverse populations and cultural competence.
• Advanced training in CBT, motivational interviewing, or dialectical behavior therapy (DBT).
• Current State RN licensure or multi-state licensure via eNLC; CCM certification within 36 months.

Responsibilities

• Manage a caseload of members with complex health needs.
• Develop and implement individualized care plans.
• Coordinate services with physicians and other providers.
• Monitor member progress toward goals and adjust plans as needed.
• Advocate for members to meet individual healthcare needs within contract benefits.
• Document all activities in compliance with policies and regulatory standards.

Skills

Leadership

Mentoring

Negotiation

Advocacy

EHR Proficiency

Oncology care

Education

High School / GED

Bachelors in Nursing

Tools

MS Office

Case management software

EHR systems

Job description

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for providing comprehensive case management services to members, ensuring quality, cost-effective care delivery, and promoting optimal health outcomes. The Case Manager assesses member needs, develops and implements care plans, coordinates services, and monitors progress, while containing the cost of health care services. The incumbent will assist in containing the cost of health care services by detecting, resolving and preventing improper utilization of member benefits.

ESSENTIAL RESPONSIBILITIES

• Manage a caseload of members with complex health needs, requiring advanced clinical knowledge.
• 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 by assessing, planning, implementing, coordinating, monitoring and evaluating options and services.
• This is accomplished by using communication and available resources to promote quality, cost-effective outcomes in accordance with available contract benefits.
• Work collaboratively and communicate clearly and professionally with physicians, providers, co-workers and other members of the health care team to carry out the established plan of care.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements, company policies, regulatory requirements and accreditation standards.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.
• Other duties as assigned or requested.

EXPERIENCE Required 5 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.

Preferred Specialty specific clinical Oncology experience

Experience working with the healthcare needs of diverse populations

Experience demonstrating understanding of importance of culture competency in addressing targeted populations

Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT) .

SKILLS Expertise in clinical Oncology assessment and care planning. Strong leadership and mentoring skills. Excellent negotiation and advocacy skills. Proficiency in using Microsoft suite of applications, case management software and electronic health records. Strong understanding of healthcare systems and case management principles.

EDUCATION Required High School/GED Preferred Bachelors in Nursing.

LICENSES or CERTIFICATIONS Required Current State Registered Nurse licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) Certified Case Manager (CCM) certification must be obtained within 36 months of hire. Incumbents in the role as of August 2026 are exempt from this requirement. Preferred Certification in clinical area of expertise (e.g., OCN, CPN, CPON, CNN, CCTC, CPHQ).

Language (Other than English): None.

Travel Required: Less than 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based or Remote Position Physical work site required Occasionally

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.

In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum: $79,300.00 Pay Range Maximum: $127,100.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.

The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at [e-mail] California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network.

Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services.

Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.