Senior RN Case Manager - Remote Care Coordination Leader

Highmark Health; Springfield (IL); Hybrid; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive, outcomes-focused care management for members with complex health needs. You will assess, plan, coordinate, and monitor services with physicians and the health team to deliver quality, cost-effective care.

Required: BSN and active RN licensure, 5+ years in case management, and CCM certification due within 36 months. Experience with CBT/MI/DBT and EMR systems is preferred; travel may be necessary.

Qualifications

• 5 years of clinical/case management or related health operations experience.
• Experience with diverse populations.
• Advanced training in CBT, motivational interviewing, or DBT.
• Expertise in clinical assessment and care planning.
• Proficiency with Microsoft Office, case management software, and EMR.
• Strong understanding of healthcare systems and case management principles.
• BSN and RN licensure or multi-state eNLC.
• CCM certification due within 36 months of hire (OCN, CPN, CPON, CNN, CCTC, CPHQ).
• Language skills beyond English as applicable.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs, and resources.
• Develop individualized care plans with members, physicians, and providers.
• Implement and coordinate care plans ensuring access to services.
• Monitor progress and adjust plans as needed.
• Advocate and liaison to meet members’ health care needs.
• Collaborate with physicians and health care team to execute the plan.
• Ensure documentation complies with policies and standards.
• Mentor lower-level Case Managers.
• Provide clinical expertise and problem-solving support.

Skills

Case management

Clinical assessment

Care planning

Communication

Interprofessional collaboration

CBT/MI/DBT training

Microsoft Office

EMR / EHR

Team mentorship

Education

Bachelor’s in Nursing (BSN)

RN licensure (State)

eNLC multi-state licensure

CCM certification (within 36 months)

Tools

Case management software

Electronic Health Records (EHR)

Microsoft Office

Job description

Highmark Health is seeking a Case Manager to provide comprehensive, outcomes-focused care management for members with complex health needs. You will assess, plan, coordinate, and monitor services with physicians and the health team to deliver quality, cost-effective care.

Required: BSN and active RN licensure, 5+ years in case management, and CCM certification due within 36 months. Experience with CBT/MI/DBT and EMR systems is preferred; travel may be necessary.