Senior Case Manager RN - Remote Care Coordination Pro

Highmark Health; Providence (RI); Remote; USD 108,000 - 146,000; Full time

Job summary

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services to members, coordinating care and ensuring cost-effective outcomes.

Responsibilities include assessments, care planning, service coordination, advocacy, and collaboration with physicians and providers, while adhering to HIPAA and compliance standards. Strong clinical knowledge and experience with CBT/MI/DBT are preferred. Travel may be required, and the role supports remote options.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management or related experience.
• Experience with diverse populations.
• Advanced training in CBT, motivational interviewing, or DBT.
• Bachelor’s in Nursing; RN licensure or multi-state licensure (eNLC).
• CCM certification must be obtained within 36 months of hire (OCN, CPN, CPON, CNN, CCTC, CPHQ).
• Strong knowledge 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 members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Act as an advocate and liaison to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services.
• Work collaboratively with physicians, providers, co-workers and other health care team members to carry out the plan of care.
• Ensure all activities are documented in compliance with policies and regulations.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.

Skills

Case management

CBT

Motivational interviewing

DBT

Microsoft Office

Electronic Health Records

Communication skills

Team collaboration

Education

Bachelor of Science in Nursing

RN licensure or eNLC

CCM certification requirement (within 36 months)

Tools

Case management software

Electronic Health Records systems

Job description

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services to members, coordinating care and ensuring cost-effective outcomes.

Responsibilities include assessments, care planning, service coordination, advocacy, and collaboration with physicians and providers, while adhering to HIPAA and compliance standards. Strong clinical knowledge and experience with CBT/MI/DBT are preferred. Travel may be required, and the role supports remote options.