Senior Case Manager RN | Remote Care Coordination Expert

Highmark Health; Clayton (NC); Remote; USD 108,000 - 146,000; Full time

Job summary

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services for members, coordinating care plans and monitoring progress to ensure quality, cost-effective outcomes.

Requirements include 5 years in clinical/case management, RN licensure, CCM certification within 36 months, CBT/MI/DBT training, and proficiency with EHRs and case management software. Collaboration with physicians and providers is essential to delivering optimal care.

Qualifications

• 5 years in clinical, case/utilization management, or related health insurance roles.
• Experience with diverse populations.
• Advanced training in CBT, motivational interviewing, or DBT.
• Expertise in clinical assessment and care planning.
• Proficiency with Microsoft Office, case management software, and EHRs.
• Strong understanding of healthcare systems and case management principles.
• Bachelor's in Nursing.

Responsibilities

• Manage a caseload of members with complex health needs and develop complex care plans.
• Assess members’ health status, needs, and resources; coordinate services.
• Implement and monitor care plans; adjust as needed for progress toward goals.
• Advocate and liaise with physicians and providers to meet member needs.
• Document activities; ensure compliance with policies, HIPAA, and regulations.
• Provide guidance to lower-level Case Managers and act as a clinical resource.

Skills

Case management

CBT/MI/DBT training

Clinical assessment

EHR proficiency

Education

Bachelors in Nursing

Tools

Microsoft Office

Case management software

Electronic health records

Job description

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services for members, coordinating care plans and monitoring progress to ensure quality, cost-effective outcomes.

Requirements include 5 years in clinical/case management, RN licensure, CCM certification within 36 months, CBT/MI/DBT training, and proficiency with EHRs and case management software. Collaboration with physicians and providers is essential to delivering optimal care.