Senior RN Case Manager: Complex Care & Advocacy (Remote)

Highmark Health; Sioux Falls (SD); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. seeks an experienced Case Manager to deliver comprehensive care management, coordinating plans and services for members to ensure quality and cost-effective outcomes.

You will assess needs, develop plans, and monitor progress, while serving as a clinical resource to the team. Requirements include RN licensure (state or multi-state via eNLC) and CCM certification within 36 months, plus 5+ years in the field.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management.
• Preferred transplant experience and care for diverse populations.
• CBT/MI/DBT training is a plus.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop care plans.
• Coordinate services and monitor progress toward goals.
• Advocate for members and ensure compliance with policies.
• Document activities and collaborate with the care team.
• Mentor lower-level Case Managers.
• Provide clinical problem-solving support.
• Travel less than 25%.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

Negotiation

EHR proficiency

Education

High School/GED

Bachelor in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records

Job description

Highmark Inc. seeks an experienced Case Manager to deliver comprehensive care management, coordinating plans and services for members to ensure quality and cost-effective outcomes.

You will assess needs, develop plans, and monitor progress, while serving as a clinical resource to the team. Requirements include RN licensure (state or multi-state via eNLC) and CCM certification within 36 months, plus 5+ years in the field.