Senior Case Manager RN - Remote Clinical Leader

Highmark Health; Baton Rouge (LA); Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services for members, coordinating care plans and resources to promote quality, cost-effective outcomes.

The role requires advanced clinical knowledge, a BSN, state RN licensure or eNLC, and CCM certification within 36 months. You will mentor junior staff and ensure HIPAA compliance and documentation across the care continuum.

Qualifications

• 5 years in clinical, case/utilization management, or related areas.
• Advanced training in CBT, motivational interviewing, or DBT.
• Proficiency with Microsoft Office, case management software, and electronic health records.
• Strong understanding of healthcare systems and case management principles.
• BSN required; RN licensure or multi-state licensure via eNLC.
• CCM certification must be obtained within 36 months of hire (OCN, CPN, CPON, CNN, CCTC, CPHQ).

Responsibilities

• Manage a caseload of members with complex health needs and develop care plans.
• Assess member health status, needs, and resources; coordinate services.
• Advocate for members and coordinate care with physicians and providers.
• Document all activities in compliance with policies and HIPAA.
• Provide guidance and mentorship to lower-level Case Managers.
• Monitor progress and adjust care plans as needed.
• Contain cost by detecting and preventing improper utilization.

Skills

Clinical knowledge

CBT experience

Motivational interviewing

DBT experience

Care planning

EHR proficiency

Microsoft Office

Education

BSN

RN license (state or eNLC)

Certified Case Manager (CCM)

Tools

Case management software

Electronic Health Records (EHR)

Microsoft Office

Job description

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services for members, coordinating care plans and resources to promote quality, cost-effective outcomes.

The role requires advanced clinical knowledge, a BSN, state RN licensure or eNLC, and CCM certification within 36 months. You will mentor junior staff and ensure HIPAA compliance and documentation across the care continuum.