Senior RN Case Manager - Remote Care Coordination Leader

Highmark Health; South Dakota; Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services for members, ensuring quality and cost-effective care. You will assess needs, develop and implement complex care plans, coordinate services, and monitor progress while mentoring junior staff.

You will work collaboratively with physicians and the health care team to ensure compliant, patient-centered care and optimize outcomes in a HIPAA-compliant environment.

Qualifications

• Active RN license in the United States or eNLC multi-state licensure.
• 5+ years in clinical, case/utilization management, or disease management.
• Experience with diverse populations and complex care coordination.
• Strong assessment, care planning, and documentation proficiency.
• Proficient with case management software and EHR systems.

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; coordinate services.
• Implement, monitor and adjust care plans with providers and members.
• Advocate for members and ensure cost-effective, quality care.
• Collaborate with physicians, providers and health care teams.
• Document activities in accordance with policies and regulations.
• Provide guidance and mentorship to junior Case Managers.
• Serve as a clinical resource for problem-solving.

Skills

Clinical knowledge

CBT/MI/DBT

Care plan development

Coordination of services

EHR systems

Microsoft Office

Advocacy

Education

Bachelor of Science in Nursing

Tools

Case management software

Electronic Health Records

MS Office

Job description

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services for members, ensuring quality and cost-effective care. You will assess needs, develop and implement complex care plans, coordinate services, and monitor progress while mentoring junior staff.

You will work collaboratively with physicians and the health care team to ensure compliant, patient-centered care and optimize outcomes in a HIPAA-compliant environment.