Senior RN Case Manager — Remote Care Coordination Leader

Highmark Health; Florida; Remoto; USD 79.000 - 127.000; Tempo pieno

Descrizione del lavoro

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services for members with complex health needs. You will assess needs, develop and implement care plans, coordinate services, and monitor progress while containing healthcare costs.

You will collaborate with physicians and the health care team to ensure access to services, document activities, and mentor junior staff. Strong clinical knowledge and leadership are essential.

Competenze

• 5 years in clinical, case/utilization management, disease condition management, or health insurance experience.

Mansioni

• 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 resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Advocate and liaison to meet members’ health needs using available resources and contract benefits.
• Collaborate with physicians, providers, co-workers and others to execute the plan of care.
• Ensure activities are documented and compliant with policies and regulations.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.
• Other duties as assigned.

Conoscenze

Clinical assessment

Care planning

Leadership and mentoring

Negotiation and advocacy

Microsoft Office / EHR

Formazione

High School / GED

Bachelor’s in Nursing (preferred)

Strumenti

Microsoft Office

Case management software

Electronic Health Records (EHR)

Descrizione del lavoro

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services for members with complex health needs. You will assess needs, develop and implement care plans, coordinate services, and monitor progress while containing healthcare costs.

You will collaborate with physicians and the health care team to ensure access to services, document activities, and mentor junior staff. Strong clinical knowledge and leadership are essential.