Senior Case Manager RN - Remote Advocate for Complex Care

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

Job summary

Highmark Health in Pittsburgh, PA seeks a skilled Case Manager to provide comprehensive case management services to members, coordinating care, assessing needs, and developing care plans to promote quality outcomes and cost containment.

You will collaborate with physicians and healthcare teams, advocate for members, mentor junior staff, and ensure documentation complies with HIPAA and company policies. Minimum 5 years of relevant experience required; RN licensure preferred.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management experience.
• Transplant experience and diverse populations exposure preferred.
• CBT/MI/DBT training and experience preferred.

Responsibilities

• Manage a caseload of members with complex health needs.
• Develop and implement individualized care plans.
• Coordinate services with physicians, providers and the healthcare team.
• Monitor progress and adjust care plans as needed.
• Advocate for members to obtain appropriate services within contract benefits.
• Document activities in compliance with policies and regulations.
• Mentor lower-level Case Managers.
• Communicate clearly with healthcare professionals and members.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

Advocacy

Microsoft Suite

EMR/EHR

Education

High School/GED

Bachelor's in Nursing

Tools

Case management software

Electronic Health Records (EHR)

Microsoft Office

Job description

Highmark Health in Pittsburgh, PA seeks a skilled Case Manager to provide comprehensive case management services to members, coordinating care, assessing needs, and developing care plans to promote quality outcomes and cost containment.

You will collaborate with physicians and healthcare teams, advocate for members, mentor junior staff, and ensure documentation complies with HIPAA and company policies. Minimum 5 years of relevant experience required; RN licensure preferred.