Senior RN Case Manager — Complex Care Coordinator (Remote)

Highmark Health; Honolulu (HI); Hybrid; USD 79,000 - 127,000; Full time

Job summary

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

You will assess needs, develop and implement care plans, coordinate services, and monitor progress while containing costs. The role requires strong clinical knowledge, collaboration with physicians and the healthcare team, and documentation compliance across applicable policies.

Qualifications

• Requires 5 years in clinical/case/utilization management or disease condition management.
• Preferred transplant experience and care for diverse populations; culture competency.
• RN licensure in state or multi-state via eNLC; CCM certification within 36 months of hire.

Responsibilities

• Manage a caseload of members with complex health needs and develop complex care plans.
• Assess health status, needs, and resources; implement coordinated care plans.
• Collaborate with physicians, providers, and team to ensure access to services.
• Monitor progress, evaluate interventions, and adjust plans as needed.
• Mentor lower-level Case Managers and document all activities per policy.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

Negotiation

EHR proficiency

Education

High School/GED

Bachelor's in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records

Job description

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

You will assess needs, develop and implement care plans, coordinate services, and monitor progress while containing costs. The role requires strong clinical knowledge, collaboration with physicians and the healthcare team, and documentation compliance across applicable policies.