Senior Case Manager RN - Remote Care Coordination Lead

Highmark Health; Bristol (RI); Hybrid; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services for members with complex health needs. You will assess, plan, coordinate, and monitor care while containing costs and ensuring quality outcomes.

Responsibilities include developing individualized care plans, collaborating with physicians and providers, and mentoring junior case managers. Strong clinical knowledge and licensure are essential.

Qualifications

• 5 years in clinical, case/utilization management or related health operations experience.
• Experience with diverse populations and healthcare systems.
• Strong knowledge of care planning and assessment processes.

Responsibilities

• Manage a caseload of members with complex health needs.
• Develop and implement individualized care plans with providers.
• Coordinate services and monitor progress toward goals.
• Advocate and liaison to ensure cost-effective outcomes within contract benefits.
• Document activities in compliance with policies and regulations.

Skills

CBT/MI/DBT training

Microsoft Office proficiency

Communication excellence

Education

Bachelor's in Nursing

RN licensure (state or eNLC)

CCM within 36 months of hire

Tools

Electronic Health Records

Case management software

Job description

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services for members with complex health needs. You will assess, plan, coordinate, and monitor care while containing costs and ensuring quality outcomes.

Responsibilities include developing individualized care plans, collaborating with physicians and providers, and mentoring junior case managers. Strong clinical knowledge and licensure are essential.