Senior Case Manager RN — Remote Care Coordination Leader

Highmark Health; Maryland City (MD); Remote; USD 108,000 - 146,000; Full time

Job summary

Highmark Health is hiring a Case Manager to provide comprehensive case management services for members, focusing on quality, cost-effective care and optimal health outcomes.

You will assess member needs, develop and implement care plans, coordinate services, and monitor progress, while containing costs and ensuring compliance with regulations. Collaboration with physicians and the health care team is essential, with guidance provided to less-experienced staff.

Qualifications

• 5 years in clinical, case/utilization management or related experience.
• Experience with diverse populations and healthcare needs.
• Advanced training in CBT, motivational interviewing or DBT.
• Clinical assessment and care planning expertise.
• Proficiency with MS Office, case management software and EHR.
• Strong understanding of healthcare systems and case management principles.
• BSN degree and current RN licensure.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs and resources of members.
• Develop individualized care plans with members, physicians and providers.
• Coordinate and implement care plans while ensuring access to services.
• Monitor progress toward goals and adjust plans as needed.
• Advocate and liaise to meet members' health care needs using available resources.
• Communicate clearly with physicians, providers and care team to execute the plan.
• Document activities in compliance with policies and regulations.
• Provide guidance and mentorship to junior Case Managers.
• Serve as a resource for clinical expertise and problem-solving.

Skills

Clinical case management

CBT

Motivational interviewing

DBT

EHR proficiency

MS Office

Care coordination

Team mentorship

Communication

Collaboration

Education

BSN

RN license (state or eNLC)

CCM certification (within 36 months)

Tools

Case management software

Electronic Health Records

Job description

Highmark Health is hiring a Case Manager to provide comprehensive case management services for members, focusing on quality, cost-effective care and optimal health outcomes.

You will assess member needs, develop and implement care plans, coordinate services, and monitor progress, while containing costs and ensuring compliance with regulations. Collaboration with physicians and the health care team is essential, with guidance provided to less-experienced staff.