Senior RN Case Manager – Complex Care, Remote

Highmark Health; Atlanta (GA); Remote; USD 120,000 - 135,000; Full time

Job summary

Highmark Health is seeking a Case Manager to deliver comprehensive care management for members with complex health needs. You will assess needs, plan care, coordinate services, and monitor outcomes while containing costs.

The role requires RN licensure, 5+ years in related fields, and CCM certification within 36 months. Strong CBT/MI/DBT training and EHR proficiency are preferred. Office-based or remote position with travel as needed.

Qualifications

• 5 years in clinical, case/utilization, disease management or provider operations/health insurance.
• Bachelor's in Nursing required; RN licensure and CCM within 36 months are expected.

Responsibilities

• Provide comprehensive case management to members with complex health needs within approved contract benefits.
• Develop and implement individualized care plans; coordinate services and monitor progress.
• Advocate for members and liaise with physicians and providers to ensure access to quality care.
• Document activities in compliance with HIPAA, policy requirements and accreditation standards.

Skills

Advanced clinical knowledge

Care coordination

EHR experience

Microsoft Office

Education

Bachelor's in Nursing

RN licensure (state or eNLC)

Tools

Case management software

EHR systems

Job description

Highmark Health is seeking a Case Manager to deliver comprehensive care management for members with complex health needs. You will assess needs, plan care, coordinate services, and monitor outcomes while containing costs.

The role requires RN licensure, 5+ years in related fields, and CCM certification within 36 months. Strong CBT/MI/DBT training and EHR proficiency are preferred. Office-based or remote position with travel as needed.