Senior Case Manager RN - Remote Care Coordination & Mentorship

Highmark Health; Yuma (AZ); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a seasoned Case Manager to deliver comprehensive case management services to members, developing and coordinating care plans to promote quality outcomes. You will assess needs, coordinate services, monitor progress, and advocate within contract benefits.

The role requires 5 years in clinical/case management or related health insurance operations, RN licensure (or eNLC), CCM within 36 months, and experience serving diverse populations. Travel <25%, office-based or remote, salary range provided.

Qualifications

• Must have clinical assessment and care planning expertise.
• Proven leadership and mentoring abilities.
• Strong negotiation and advocacy skills.
• Proficiency with Microsoft Office, case management software and EHRs.
• Solid understanding of healthcare systems and case management principles.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs, and resources.
• Develop individualized care plans with members, physicians, and providers.
• Coordinate and implement care plans ensuring access to services.
• Monitor progress and adjust plans as needed.
• Evaluate intervention effectiveness.
• Act as advocate and liaison to meet health care needs within contract benefits.
• Collaborate with physicians, providers, and healthcare team.

Skills

Clinical assessment

Care planning

Leadership mentoring

Negotiation advocacy

EHR proficiency

Healthcare systems knowledge

Education

High School/GED

Bachelor's in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records

Job description

Highmark Inc. is seeking a seasoned Case Manager to deliver comprehensive case management services to members, developing and coordinating care plans to promote quality outcomes. You will assess needs, coordinate services, monitor progress, and advocate within contract benefits.

The role requires 5 years in clinical/case management or related health insurance operations, RN licensure (or eNLC), CCM within 36 months, and experience serving diverse populations. Travel <25%, office-based or remote, salary range provided.