Senior Oncology Case Manager RN | Care Coordination Leader

Highmark Health; Central City (CO); Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services, develop and implement care plans, coordinate services, and monitor progress for members with complex health needs. The role emphasizes cost-effective care delivery and preventing improper utilization of benefits.

You will work with physicians, providers, and healthcare teams to ensure access to necessary services, document activities, and maintain compliance with HIPAA and company policies.

Qualifications

• 5 years in clinical, case/utilization, or disease management experience.
• Experience with Oncology, Transplant, Maternity, NICU, or Pediatric populations.
• Experience with diverse populations in healthcare settings.
• Advanced training in CBT, motivational interviewing, or DBT.
• Expertise in clinical assessment and care planning.
• Proficiency with Microsoft Office, case management software, and EHRs.
• Strong understanding of healthcare systems and case management principles.
• RN licensure with Bachelor degree in Nursing.

Responsibilities

• Manage a caseload of members with complex health needs requiring advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members and providers.
• Coordinate and implement care plans with access to services and resources.
• Monitor progress and adjust plans as needed.
• Advocate for members and coordinate care using available resources.
• Collaborate with physicians, providers, and team members to execute the plan of care.
• Ensure documentation complies with policies, regulations, and standards.
• Provide guidance to junior Case Managers and serve as a clinical resource.

Skills

Clinical assessment

Care coordination

CBT/MI/DBT

EHR proficiency

Healthcare systems understanding

Education

Bachelors in Nursing

Tools

Microsoft Office

Electronic Health Records (EHR)

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services, develop and implement care plans, coordinate services, and monitor progress for members with complex health needs. The role emphasizes cost-effective care delivery and preventing improper utilization of benefits.

You will work with physicians, providers, and healthcare teams to ensure access to necessary services, document activities, and maintain compliance with HIPAA and company policies.