Senior RN Case Manager (Remote): Care Coordination & Outcomes

Highmark Health; Phoenix (AZ); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, coordinating care, assessing member needs, and developing care plans to optimize outcomes while containing costs.

You will collaborate with physicians and providers, document activities per regulations, and mentor junior staff. Experience in complex case management and familiarity with CBT/DBT techniques is preferred.

Qualifications

• 5 years in clinical or case/utilization management or health insurance experience.
• Transplant-specific clinical experience.
• Experience with diverse populations.
• CBT/DBT/motivational interviewing training

Responsibilities

• Manage a caseload of members with complex health needs.
• Develop and implement individualized care plans.
• Coordinate services and access to resources.
• Monitor progress and adjust care plans.
• Document activities per policies and HIPAA/privacy rules.
• Provide guidance to junior Case Managers.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

EHR proficiency

Education

High School/GED

Bachelor’s in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, coordinating care, assessing member needs, and developing care plans to optimize outcomes while containing costs.

You will collaborate with physicians and providers, document activities per regulations, and mentor junior staff. Experience in complex case management and familiarity with CBT/DBT techniques is preferred.