Senior Case Manager RN - Remote with Mentorship

Highmark Health; North Dakota; Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services to members, coordinating care plans and resources to achieve quality, cost-effective outcomes. You will assess needs, develop and implement plans, monitor progress and advocate for members within contract guidelines.

Requirements include 5 years of clinical or utilization management experience, RN licensure or multi-state licensure through eNLC, and CCM certification within 36 months.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management experience.
• RN licensure OR CCM certification must be obtained within 36 months of hire.
• Knowledge of HIPAA and privacy standards.

Responsibilities

• Manage a caseload of members with complex health needs.
• Develop and implement individualized care plans.
• Coordinate services and access to resources.
• Monitor member progress and adjust plans as needed.
• Advocate for cost-effective care within contract benefits.
• Document activities in compliance with policies and procedures.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

EHR systems

Education

High School/GED

Bachelors in Nursing

Tools

Case management software

Microsoft Office

Job description

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services to members, coordinating care plans and resources to achieve quality, cost-effective outcomes. You will assess needs, develop and implement plans, monitor progress and advocate for members within contract guidelines.

Requirements include 5 years of clinical or utilization management experience, RN licensure or multi-state licensure through eNLC, and CCM certification within 36 months.