Senior RN Case Manager: Complex Care & Advocacy

Highmark Health; Heber (UT); Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health seeks a Case Manager to deliver comprehensive case management for members with complex health needs. The role involves assessments, care planning, coordination, and monitoring to ensure quality, cost-effective care and outcomes in line with contract benefits.

The position requires RN licensure (in-state or eNLC), CCM certification within 36 months, and 5+ years in clinical/case management or related health-insurance experience. Strong collaboration and documentation are essential.

Qualifications

• Current State RN licensure OR current multi-state licensure via eNLC.
• CCM certification must be obtained within 36 months of hire.
• 5 years in clinical/case management or health insurance experience.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members' health status, needs and resources.
• Develop individualized care plans with members and providers.
• Implement and coordinate care plans with access to services.
• Monitor progress and adjust care plans as needed.
• Advocate and liaise to meet members' health care needs.
• Collaborate with physicians and providers to carry out plans.
• Ensure activities comply with policies and accreditation standards.
• Provide guidance to lower-level Case Managers.
• Serve as a clinical resource and problem-solver.

Skills

Clinical assessment

Care planning

CBT

Motivational interviewing

DBT

Microsoft Office

EHR systems

Team collaboration

Education

Bachelor of Science in Nursing

Tools

Case management software

Electronic Health Records

Microsoft Excel

Job description

Highmark Health seeks a Case Manager to deliver comprehensive case management for members with complex health needs. The role involves assessments, care planning, coordination, and monitoring to ensure quality, cost-effective care and outcomes in line with contract benefits.

The position requires RN licensure (in-state or eNLC), CCM certification within 36 months, and 5+ years in clinical/case management or related health-insurance experience. Strong collaboration and documentation are essential.