Senior RN Case Manager - Remote Care Coordination

Highmark Health; Clifton (TX); Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services, coordinating care plans and monitoring outcomes for members with complex health needs.

The role requires extensive clinical knowledge, licensure, and CCM certification within 36 months, with a focus on quality, cost-effective care and collaboration with physicians and the health care team.

Qualifications

• 5 years in clinical, case/utilization management, or health insurance experience.
• Experience with diverse populations.
• Advanced training in CBT, motivational interviewing, or DBT.
• Clinical assessment and care planning expertise.
• Proficiency with Microsoft Office, case management software and EHRs.
• Understanding of healthcare systems and case management principles.
• Bachelor of Nursing degree.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop care plans.
• Assess health status, needs, and resources.
• Coordinate access to services and resources.
• Monitor progress and adjust plans as needed.
• Advocate and liaison to meet members' health care needs.
• Collaborate with physicians and health care providers.
• Ensure documentation complies with policies and standards.
• Provide guidance to lower-level Case Managers.
• Serve as a clinical resource and problem-solver.

Skills

Microsoft Office

Case management software

Electronic Health Records

Education

Bachelors in Nursing

RN licensure (state)

CCM (certification) within 36 months

Job description

Highmark Health is seeking a skilled Case Manager to provide comprehensive case management services, coordinating care plans and monitoring outcomes for members with complex health needs.

The role requires extensive clinical knowledge, licensure, and CCM certification within 36 months, with a focus on quality, cost-effective care and collaboration with physicians and the health care team.