Senior RN Case Manager (Remote) – Care Coordination

highmarkhealth; United States; Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a skilled Case Manager to deliver comprehensive case management for members, focusing on quality, cost-effective care and optimal health outcomes.

The role involves assessing needs, developing care plans, coordinating services, and monitoring progress while containing costs. Required: 5 years in clinical/case management or health insurance operations, active RN licensure, and CCM within 36 months.

Qualifications

• 5 years in clinical, case/utilization management, disease condition management, or health insurance operations.
• RN licensure active in state or via eNLC.
• CCM certification must be obtained within 36 months of hire (exempt for current incumbents).
• Transplant experience or population health experience is preferred.

Responsibilities

• Manage a caseload of members with complex health needs and advanced clinical requirements.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs and resources of members.
• Coordinate and implement care plans with physicians and providers.
• Monitor progress and adjust plans; document all activities per policies.
• Provide guidance and mentorship to junior Case Managers.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

Advocacy

EHR / case management software

Education

High School/GED

Bachelor's in Nursing

Tools

Case management software

Electronic Health Records

Job description

Highmark Inc. is seeking a skilled Case Manager to deliver comprehensive case management for members, focusing on quality, cost-effective care and optimal health outcomes.

The role involves assessing needs, developing care plans, coordinating services, and monitoring progress while containing costs. Required: 5 years in clinical/case management or health insurance operations, active RN licensure, and CCM within 36 months.