Senior Remote RN Case Manager - Care Coordination Leader

Highmark Health; Northern (KY); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Senior Case Manager RN for a remote role based in Pennsylvania. You will manage complex patient caseloads, conduct comprehensive assessments, and develop and coordinate care plans with a multidisciplinary team to promote cost-effective, quality outcomes.

The position requires 5 years of clinical or utilization management experience, active RN licensure (or multi-state via eNLC), and CCM certification within 36 months. Travel is less than 25% and work is remote.

Qualifications

• 5 years in clinical, case/utilization management, or health insurance experience.
• RN licensure active (state or multi-state via eNLC) or CCM certification within 36 months.
• Specialty clinical experience (e.g., Oncology, Transplant, Maternity) preferred.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Coordinate services and monitor progress toward goals.
• Collaborate with physicians and other providers to implement care plans.
• Advocate for members and ensure documentation complies with HIPAA and policies.
• Mentor lower-level Case Managers and provide clinical guidance.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

Advocacy

Microsoft Office

EHR systems

Education

Bachelor's in Nursing

Tools

Case management software

Electronic Health Records

Job description

Highmark Inc. is seeking a Senior Case Manager RN for a remote role based in Pennsylvania. You will manage complex patient caseloads, conduct comprehensive assessments, and develop and coordinate care plans with a multidisciplinary team to promote cost-effective, quality outcomes.

The position requires 5 years of clinical or utilization management experience, active RN licensure (or multi-state via eNLC), and CCM certification within 36 months. Travel is less than 25% and work is remote.