Senior Case Manager RN - Remote Care Coordinator

Highmark Health; Elm (PA); À distance; USD 79 000 - 127 000; Plein temps

Résumé du poste

Highmark Health is seeking a Case Manager to deliver comprehensive case management services for members, focusing on quality and cost-effective care. The role involves assessing needs, developing and coordinating care plans, and monitoring progress to promote optimal health outcomes.

You will work with physicians, providers, and the care team to ensure access to services, containment of costs, and adherence to contract benefits. Strong clinical knowledge and advocacy are essential.

Qualifications

• Experience in case management, utilization management, and/or disease condition management.
• Ability to coordinate and develop care plans with physicians and providers.
• Knowledge of HIPAA and privacy policies and procedures and compliance requirements.

Responsabilités

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop care plans.
• Coordinate services and monitor progress to meet goals.
• Advocate for members and liaise with healthcare providers.
• Document activities in compliance with policies and standards.

Connaissances

Clinical assessment

Leadership

Negotiation

Case management software

Electronic Health Records

Healthcare systems

Formation

High School/GED

Bachelor’s in Nursing

Outils

Microsoft Office

Case management software

Electronic Health Records

Description du poste

Highmark Health is seeking a Case Manager to deliver comprehensive case management services for members, focusing on quality and cost-effective care. The role involves assessing needs, developing and coordinating care plans, and monitoring progress to promote optimal health outcomes.

You will work with physicians, providers, and the care team to ensure access to services, containment of costs, and adherence to contract benefits. Strong clinical knowledge and advocacy are essential.