Senior RN Case Manager — Complex Care & Coordination

Highmark Health; Frankfort (KY); Remote; USD 86,000 - 139,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services for members with complex needs, coordinating care plans and monitoring progress to promote optimal health outcomes.

You will assess needs, develop individualized plans with physicians and providers, and implement strategies to contain costs while ensuring access to needed services. Strong collaboration with care teams and documentation in compliance are essential.

Qualifications

• Bachelor’s degree in Nursing or equivalent experience as determined by the company.
• CCM certification must be obtained within 36 months of hire (exemption for incumbents as of Aug 2026).
• Experience in case management, utilization management, or disease condition management is preferred.

Responsibilities

• Provide case management to members with complex needs (e.g., transplant, oncology, pediatrics).
• Oversee a panel of members and assess health management needs.
• Develop and implement strategies to improve outcomes and reduce costs for specialized populations.
• Assess health status, needs, and resources; coordinate care plans with providers.
• Implement and coordinate care plans, ensuring access to services.
• Monitor progress and adjust plans; evaluate intervention effectiveness.
• Act as advocate and liaison to meet health care needs respecting contract benefits.
• Collaborate with physicians and health care team; document activities in compliance.

Skills

Care management knowledge

Healthcare navigation

Analytical skills

EHR & case management software

Communication skills

Generative AI

Data interpretation

Education

Bachelor’s degree in Nursing or equivalent

CCM certification (within 36 months)

Tools

Case management software

Electronic Health Records (EHR)

Job description

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services for members with complex needs, coordinating care plans and monitoring progress to promote optimal health outcomes.

You will assess needs, develop individualized plans with physicians and providers, and implement strategies to contain costs while ensuring access to needed services. Strong collaboration with care teams and documentation in compliance are essential.