Senior RN Case Manager — Remote Care & Coordination

Highmark; United States; Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and implement care plans, and coordinate services to promote quality, cost-effective care outcomes. The role focuses on maintaining appropriate utilization and optimizing health outcomes for members.

You will work with physicians and health care teams to implement plans, monitor progress, and adjust as needed, ensuring documentation meets regulatory and contract requirements.

Qualifications

• RN licensure in good standing or equivalent multi-state license
• CCM certification is preferred or must be obtained within 36 months of hire (exemption applies for Aug 2026 hires)
• Experience in case management, utilization management or oncology care is desirable

Responsibilities

• Manage a caseload of members with complex health needs and advanced clinical knowledge.
• Develop and coordinate complex care plans with members, families, and providers.
• Assess health status, needs, and resources; adjust plans as progress occurs.
• Act as advocate and liaison to optimize access to needed services and benefits.
• Document activities in compliance with policies and regulatory requirements.

Skills

Oncology care

Leadership

Advocacy

EHR systems

Healthcare knowledge

Education

High School/GED

Bachelor's in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and implement care plans, and coordinate services to promote quality, cost-effective care outcomes. The role focuses on maintaining appropriate utilization and optimizing health outcomes for members.

You will work with physicians and health care teams to implement plans, monitor progress, and adjust as needed, ensuring documentation meets regulatory and contract requirements.