Senior Case Manager RN - Oncology (Remote)

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

Job summary

Highmark Health is hiring a Senior Case Manager RN - Oncology in Pennsylvania to coordinate complex care and advocate for members. You will assess health needs, build individualized plans, and work with physicians and care teams to ensure access to services.

Strong nursing background and case management experience are required, with CCM certification pursued within 36 months. The role emphasizes comprehensive assessments, care coordination, documentation, and collaboration to achieve optimal

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management experience required.
• Specialty specific clinical experience preferred.
• 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 the healthcare team.
• Ensure all activities are documented in compliance with applicable requirements.

Skills

Case management

Nursing knowledge

Advocacy

Collaboration

Education

High School/GED

Bachelor's in Nursing preferred

Job description

About This Role

The Senior Case Manager RN - Oncology is responsible for providing comprehensive case management services to members, ensuring quality and cost-effective care delivery while promoting optimal health outcomes. This role is ideal for experienced nurses with advanced clinical knowledge and a passion for patient advocacy.

Highlights

• Pay: $79,300 - $127,100/year
• Location: Pa, US
• Schedule: Full-time

What You’ll Do

• 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 the healthcare team.
• Ensure all activities are documented in compliance with applicable requirements.

Requirements

Education

• High School/GED required
• Bachelor's in Nursing preferred

Experience

• 5 years in clinical, case/utilization management, and/or disease condition management experience required
• Specialty specific clinical experience preferred

Licenses & Certifications

• Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) required
• Certified Case Manager (CCM) certification must be obtained within 36 months of hire

About Highmark Health

Highmark Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on innovative solutions to improve health outcomes and enhance the patient experience.