Senior Case Manager RN Remote Care Leader

Highmark Health; Salem (OR); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking an experienced Case Manager to provide comprehensive case management services for members, develop and monitor complex care plans, and coordinate services with physicians and other providers to ensure quality, cost-effective outcomes.

The role emphasizes leadership, mentorship, and adherence to HIPAA, with CCM certification encouraged within 36 months of hire. Office-based or remote options may be available for qualified candidates.

Qualifications

• 5+ years in clinical, case/utilization management or health insurance roles.
• Experience with complex member populations and care coordination.
• CCM certification or plan to obtain within 36 months of hire (exempt for current hires).

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop care plans.
• Coordinate services and monitor progress toward goals.
• Collaborate with physicians and other providers to ensure appropriate care.
• Ensure documentation and compliance with policies and HIPAA requirements.
• Mentor lower-level Case Managers and serve as clinical resource.

Skills

Clinical assessment

Care planning

Leadership & mentoring

Negotiation & advocacy

Healthcare systems knowledge

Education

High School/GED

Bachelors in Nursing

Tools

Microsoft Office

Electronic Health Records

Case management software

Job description

Highmark Inc. is seeking an experienced Case Manager to provide comprehensive case management services for members, develop and monitor complex care plans, and coordinate services with physicians and other providers to ensure quality, cost-effective outcomes.

The role emphasizes leadership, mentorship, and adherence to HIPAA, with CCM certification encouraged within 36 months of hire. Office-based or remote options may be available for qualified candidates.