Senior Oncology Case Manager RN (Remote)

Highmark Health; West Virginia; Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services, assessing member needs, developing care plans, coordinating services, and monitoring progress toward quality, cost-effective outcomes. The role emphasizes collaboration with physicians and care teams while upholding HIPAA and regulatory standards.

Candidate must have a nursing background with at least 5 years of related experience, including utilization management.

Qualifications

• 5 years in clinical, case/utilization, or disease management experience.
• Oncology, Transplant, Maternity, NICU, Pediatric experience noted.
• Experience with diverse populations in healthcare.
• Advanced training in CBT, motivational interviewing, or DBT.
• Expertise in clinical assessment and care planning.
• Proficiency with Microsoft Office and case management software.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct assessments and develop complex care plans.
• Assess health status, needs, and resources.
• Collaborate with members, physicians, and providers to plan care.
• Coordinate and monitor care plans to ensure access to services.
• Document activities in compliance with policies and regulations.

Skills

Clinical experience

Case management

Utilization management

Nursing background (RN)

CBT/MI/DBT training

EHR software

Microsoft Office

Education

Bachelor of Science in Nursing

Tools

Electronic Health Records

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services, assessing member needs, developing care plans, coordinating services, and monitoring progress toward quality, cost-effective outcomes. The role emphasizes collaboration with physicians and care teams while upholding HIPAA and regulatory standards.

Candidate must have a nursing background with at least 5 years of related experience, including utilization management.