Senior Oncology Case Manager RN — Remote

Highmark Health; Louisiana; Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services for members, coordinating care, developing plans, and monitoring progress to promote quality outcomes while containing healthcare costs.

The role requires extensive clinical knowledge, strong leadership, and collaboration with physicians and the care team to implement plans and ensure access to services. Relevant licensure and CCM certification are expected within specified timelines.

Qualifications

• 5 years in clinical, case/utilization management, or disease condition management, or provider operations/health insurance experience.
• Active RN license in state or multi-state via eNLC.
• CCM certification must be obtained within 36 months of hire (exempt for incumbents as of Aug 2026).
• Preferred: specialty clinical experience (e.g., Oncology, Transplant, Maternity, NICU, Pediatric).
• Preferred: experience with diverse populations and cultural competency.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs, and available resources.
• Develop individualized care plans with members, physicians, and providers.
• Coordinate and monitor care plans to access appropriate services.
• Evaluate effectiveness of interventions and services.
• Act as advocate and liaison to meet member health care needs within contract benefits.
• Collaborate with physicians, providers, and health care team to execute the plan.
• Ensure documentation complies with policies, laws, and accreditation standards.
• Provide guidance and mentorship to lower-level Case Managers.

Skills

Clinical assessment

Care planning

Leadership & mentoring

Advocacy & negotiation

EHR & software proficiency

Education

High School/GED

Bachelor's in Nursing (preferred)

Tools

Microsoft Office

EHR systems

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services for members, coordinating care, developing plans, and monitoring progress to promote quality outcomes while containing healthcare costs.

The role requires extensive clinical knowledge, strong leadership, and collaboration with physicians and the care team to implement plans and ensure access to services. Relevant licensure and CCM certification are expected within specified timelines.