Senior Case Manager RN - Remote Care Coordination

Highmark Health; Louisiana; Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a Case Manager to deliver comprehensive case management services, coordinating care for members with complex health needs and containing costs. The role emphasizes collaboration with physicians, providers, and the care team, while ensuring compliance and quality outcomes.

The candidate will assess, plan, implement, and monitor care plans, acting as an advocate to optimize health and cost-effective services. Requires RN licensure and CCM certification within 36 months.

Qualifications

• Experience with diverse populations
• Advanced training in CBT, motivational interviewing, or DBT
• Clinical assessment and care planning expertise
• Proficiency with Microsoft Office, case management software and EHR
• Understanding of healthcare systems and case management principles
• Bachelor's in Nursing (BSN) required

Responsibilities

• Manage a caseload of members with complex health needs and coordinate care
• Conduct comprehensive assessments and develop complex care plans
• Assess health status, needs, and resources
• Develop individualized care plans with members, physicians, and providers
• Implement and coordinate care plans to ensure access to services
• Monitor progress and adjust care plans as needed
• Advocate and coordinate to meet health care needs per contract benefits
• Collaborate with physicians and the health care team
• Ensure documentation and compliance with policies and regulations
• Provide guidance to lower-level Case Managers
• Serve as a resource for clinical expertise and problem-solving
• 5 years of relevant experience in clinical, case/utilization management, or related fields

Skills

Case management

Clinical assessment

Care planning

Communication

Collaboration

Mentorship

EHR

Microsoft Office

Education

Bachelor's in Nursing

Tools

Electronic Health Records

Case management software

Microsoft Office

Job description

Highmark Health is seeking a Case Manager to deliver comprehensive case management services, coordinating care for members with complex health needs and containing costs. The role emphasizes collaboration with physicians, providers, and the care team, while ensuring compliance and quality outcomes.

The candidate will assess, plan, implement, and monitor care plans, acting as an advocate to optimize health and cost-effective services. Requires RN licensure and CCM certification within 36 months.