Senior RN Case Manager — Remote Care Coordination Leader

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

Job summary

Highmark Health is seeking a Case Manager to deliver comprehensive case management services, coordinating care plans and monitoring progress to promote quality and cost-effective outcomes. The role involves working with physicians and care teams to ensure appropriate services and resources are accessible, while containing healthcare costs.

The ideal candidate has 5 years of clinical or utilization management experience, RN licensure, CCM consideration within 36 months, and strong knowledge of

Qualifications

• 5 years in clinical, case/utilization management, or disease condition management.
• Experience with diverse populations and complex health needs.
• Advanced training in CBT, motivational interviewing, or DBT.
• Bachelors in Nursing and current RN licensure (or eNLC).
• CCM certification must be obtained within 36 months of hire.

Responsibilities

• Manage a caseload of members with complex health needs and develop care plans.
• Coordinate services, monitor progress, and advocate for members.
• Assess health status, needs, and available resources; document activities.
• Collaborate with physicians and providers to implement plans.
• Ensure compliance with policies, regulations, and privacy rules.
• Provide mentorship to lower-level Case Managers.

Skills

Clinical assessment

Care planning

Case management

Communication

Microsoft Office

EHR systems

Education

Bachelor's in Nursing

Tools

Case management software

Electronic Health Records

Job description

Highmark Health is seeking a Case Manager to deliver comprehensive case management services, coordinating care plans and monitoring progress to promote quality and cost-effective outcomes. The role involves working with physicians and care teams to ensure appropriate services and resources are accessible, while containing healthcare costs.

The ideal candidate has 5 years of clinical or utilization management experience, RN licensure, CCM consideration within 36 months, and strong knowledge of