Senior RN Case Manager - Remote Care Coordination

Highmark Health; Colorado; Hybrid; USD 114,000 - 140,000; Full time

Job summary

Highmark Health in Colorado is seeking a Case Manager to provide comprehensive management services for members with complex health needs, focusing on quality care and cost containment. You will assess needs, develop and implement care plans, coordinate services and monitor progress.

The role requires RN licensure, CCM certification within 36 months, and experience with diverse populations; you will mentor junior staff and collaborate with physicians and care teams to ensure compliant

Qualifications

• Experience with healthcare needs of diverse populations.
• Advanced training in CBT, motivational interviewing, or DBT.
• Expertise in clinical assessment and care planning.
• Strong understanding of healthcare systems and case management principles.
• Bachelors in Nursing.

Responsibilities

• Manage a caseload of members with complex health needs, requiring advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Advocate and liaison to meet members' health care needs using communication and available resources to promote quality, cost-effective outcomes.
• Collaborate with physicians, providers, coworkers, and other health care team members to carry out the established plan of care.
• Ensure activities documented in compliance with policies and accreditation standards.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.
• 5 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.

Skills

CBT

Motivational interviewing

DBT

Education

Bachelors in Nursing

Tools

Microsoft Office

Case management software

Electronic health records

Job description

Highmark Health in Colorado is seeking a Case Manager to provide comprehensive management services for members with complex health needs, focusing on quality care and cost containment. You will assess needs, develop and implement care plans, coordinate services and monitor progress.

The role requires RN licensure, CCM certification within 36 months, and experience with diverse populations; you will mentor junior staff and collaborate with physicians and care teams to ensure compliant