Senior RN Case Manager: Care Coordination Leader (Remote)

Highmark Health; Town of King (WI); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services to members, promoting quality, cost-effective care and optimal health outcomes.

You will assess needs, develop and coordinate care plans, and monitor progress with input from physicians and providers. The role requires extensive clinical knowledge, collaboration across the health care team, and strong documentation in line with policies and accreditation standards.

Qualifications

• Expertise in clinical assessment and care planning.
• Strong leadership and mentoring skills.
• Excellent negotiation and advocacy skills.
• Proficiency in Microsoft Office, case management software and EHRs.
• Strong understanding of healthcare systems and case management principles.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services.
• Work collaboratively and communicate clearly with physicians, providers, co-workers and other members of the health care team to carry out the established plan of care.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements, company policies, regulatory requirements and accreditation standards.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.
• Other duties as assigned or requested.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

EHR proficiency

Microsoft Office

Healthcare systems

Education

High School/GED

Bachelors in Nursing

Tools

Electronic Health Records

Job description

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services to members, promoting quality, cost-effective care and optimal health outcomes.

You will assess needs, develop and coordinate care plans, and monitor progress with input from physicians and providers. The role requires extensive clinical knowledge, collaboration across the health care team, and strong documentation in line with policies and accreditation standards.