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

Highmark Health; Philadelphia (Philadelphia County); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services, assess member needs, coordinate care, and monitor outcomes. The role emphasizes cost-effective care and collaboration with physicians and providers.

Requires 5 years of related experience; RN licensure or multi-state license; CCM preferred. Travel less than 25% may be required; adherence to HIPAA and company policies is essential.

Qualifications

• Required RN licensure (state) or eNLC multi-state license.
• CCM certification must be obtained within 36 months of hire (exemption for incumbents as of Aug 2026).

Responsibilities

• Manage caseloads of members with complex health needs.
• Develop and coordinate individualized care plans.
• Advocate for access to services and resources.
• Ensure documentation complies with HIPAA and policy standards.

Skills

Clinical assessment

Care planning

Leadership & mentoring

Negotiation & advocacy

MS Office & EHR

Healthcare systems knowledge

Education

High School/GED

Bachelor's in Nursing

Tools

Microsoft Office

Electronic Health Records

Job description

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services, assess member needs, coordinate care, and monitor outcomes. The role emphasizes cost-effective care and collaboration with physicians and providers.

Requires 5 years of related experience; RN licensure or multi-state license; CCM preferred. Travel less than 25% may be required; adherence to HIPAA and company policies is essential.