Senior RN Case Manager: Care Coordination Leader (Remote)

Highmark Health; New Jersey; Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. seeks an experienced Case Manager to deliver comprehensive case management services for members with complex health needs. You will assess, plan, coordinate, and monitor care to promote optimal health outcomes while containing costs.

You will collaborate with physicians, document thoroughly, and support junior staff, ensuring compliance with HIPAA and company policies. Flexible work options are available.

Qualifications

• 5 years in clinical, case/utilization management, or health insurance roles.
• RN licensure in state or multi-state via eNLC; CCM certification within 36 months.

Responsibilities

• Manage a caseload of members with complex health needs.
• Develop and implement individualized care plans.
• Coordinate services and monitor progress toward goals.
• Advocate for cost-effective, quality care.
• Document activities in compliance with policies and regulations.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

Advocacy

EHR proficiency

Microsoft Office

Healthcare systems

Education

High School/GED

Bachelor's in Nursing

Tools

Case management software

Electronic Health Records (EHR)

Microsoft Office Suite

Job description

Highmark Inc. seeks an experienced Case Manager to deliver comprehensive case management services for members with complex health needs. You will assess, plan, coordinate, and monitor care to promote optimal health outcomes while containing costs.

You will collaborate with physicians, document thoroughly, and support junior staff, ensuring compliance with HIPAA and company policies. Flexible work options are available.