Senior RN Case Manager - Care Coordination Lead (Remote)

Highmark Health; Central City (CO); Remote; USD 108,000 - 146,000; Full time

Job summary

Highmark Health in Colorado seeks a Case Manager to provide comprehensive case management services, assess member needs, develop and coordinate complex care plans, and monitor progress toward goals.

You will collaborate with physicians and the health care team, advocate for cost-effective, high‑quality outcomes, ensure compliant documentation, and mentor junior case managers while safeguarding member privacy and regulatory requirements.

Qualifications

• Current State RN licensure OR multi-state licensure through the eNLC.
• CCM certification must be obtained within 36 months of hire (OCN, CPN, CPON, CNN, CCTC, CPHQ).
• Minimum 5 years in clinical, case/utilization management, disease condition management, provider operations or health insurance.

Responsibilities

• Manage a caseload of members with complex health needs with advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans with members, physicians and providers.
• Coordinate and implement care plans ensuring access to services and resources.
• Monitor progress toward goals and adjust care plans as needed.
• Advocate and liaise to meet member health care needs while containing costs.
• Collaborate with physicians and care team; ensure clear documentation and compliance.

Skills

Clinical assessment

Care planning

CBT/MI/DBT

EHR proficiency

Healthcare systems knowledge

Population health experience

Mentorship

Education

Bachelor's Degree in Nursing

RN licensure (state) or multi-state (eNLC)

Tools

Microsoft Office

Electronic Health Records (EHR)

Case management software

Job description

Highmark Health in Colorado seeks a Case Manager to provide comprehensive case management services, assess member needs, develop and coordinate complex care plans, and monitor progress toward goals.

You will collaborate with physicians and the health care team, advocate for cost-effective, high‑quality outcomes, ensure compliant documentation, and mentor junior case managers while safeguarding member privacy and regulatory requirements.