Senior RN Case Manager: Complex Care & Cost Optimization

Highmark Health; Jackson (MS); Hybrid; USD 86,000 - 139,000; Full time

Job summary

Highmark Inc. is seeking an experienced Case Manager to deliver comprehensive case management services for members with complex needs. You will assess needs, develop care plans, coordinate services, and monitor progress to promote optimal health outcomes while containing costs.

The role requires RN licensure, 7+ years in case management or related fields, and CCM certification within 36 months of hire. Strong communication and AI-assisted data analysis skills are preferred.

Qualifications

• 7+ years of experience in case management, utilization management, or related healthcare roles.
• RN licensure current or multi-state license via eNLC.
• CCM certification must be obtained within 36 months of hire (exempt for incumbents as of Aug 2026).

Responsibilities

• Provide case management for members with highly complex or specialized needs.
• Oversee panel members with ongoing health management assessments and triage to resources.
• Develop and implement strategies to improve outcomes and reduce costs for specialized populations.
• Assess health status, needs, and resources; develop individualized care plans with providers.
• Coordinate and monitor care plans to ensure access to services and resources.
• Evaluate intervention effectiveness and adjust plans accordingly.
• Act as advocate and liaison to promote quality, cost-effective outcomes.
• Collaborate with physicians and the health care team and document activities.

Skills

Case management

Healthcare system navigation

Data analysis

Microsoft Office & EHR

Communication skills

Generative AI

Data-driven recommendations

Education

Bachelor’s degree in Nursing or relevant experience

Tools

EHR software

Case management software

Job description

Highmark Inc. is seeking an experienced Case Manager to deliver comprehensive case management services for members with complex needs. You will assess needs, develop care plans, coordinate services, and monitor progress to promote optimal health outcomes while containing costs.

The role requires RN licensure, 7+ years in case management or related fields, and CCM certification within 36 months of hire. Strong communication and AI-assisted data analysis skills are preferred.