Senior Oncology Case Manager RN - Care Coordination Leader

Highmark Health; Virginia; Remote; USD 114.000 - 140.000; Vollzeit

Zusammenfassung

Highmark Health seeks an experienced Case Manager to provide comprehensive case management for members with complex health needs. You will assess, plan, coordinate, and monitor care while containing costs and ensuring high-quality outcomes.

The role requires advanced clinical knowledge, experience with diverse populations, and certification in CCM within 36 months. Collaboration with physicians and care teams is essential, with documentation aligned to policies and HIPAA requirements.

Qualifikationen

• 5 years in clinical/case/utilization management or related health-insurance operations.
• Experience with diverse populations and health care needs.
• CBT, motivational interviewing, or DBT training/experience.
• Expertise in clinical assessment and care planning.
• Proficiency with Microsoft Office and case management software/EHRs.
• Strong understanding of healthcare systems and case management principles.
• Bachelor's in Nursing and active RN licensure.

Aufgaben

• Manage a caseload of members with complex health needs requiring advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs and available resources of members.
• Coordinate and implement care plans with providers and members.
• Monitor progress and adapt care plans as needed.
• Advocate for members and ensure compliant, cost-effective outcomes.
• Collaborate with physicians, providers, and health team members.
• Document all activities in accordance with policies and regulations.
• Provide guidance and mentorship to junior Case Managers.
• Serve as a clinical resource for problem-solving.

Kenntnisse

5+ years experience

Clinical assessment

Care planning

CBT / MI / DBT training

EHR & CM software

Microsoft Office

Healthcare systems knowledge

Ausbildung

Bachelor's in Nursing

RN licensure

CCM certification (within 36 months)

Tools

Electronic Health Records

Case management software

Jobbeschreibung

Highmark Health seeks an experienced Case Manager to provide comprehensive case management for members with complex health needs. You will assess, plan, coordinate, and monitor care while containing costs and ensuring high-quality outcomes.

The role requires advanced clinical knowledge, experience with diverse populations, and certification in CCM within 36 months. Collaboration with physicians and care teams is essential, with documentation aligned to policies and HIPAA requirements.