Senior RN Case Manager - Remote Care Coordinator

Highmark Health; United States; Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management for members, developing care plans and coordinating services to promote optimal health outcomes while containing costs.

The role requires extensive clinical knowledge with five years of related experience, RN licensure, and CCM certification within 36 months. Remote position with occasional travel and collaboration with physicians and providers.

Qualifications

• Minimum 5 years in clinical, case/utilization management, or disease condition management, or provider operations/health insurance experience.
• Transplant specific clinical experience
• Experience with diverse populations and culture competency
• CBT/MI/DBT training or experience

Responsibilities

• Manage a caseload of members with complex health needs.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Coordinate services and monitor progress toward goals.
• Advocate for members and align care with contract benefits.
• Document activities in compliance with policies and regulatory requirements.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

EHR proficiency

MS Office

Healthcare systems knowledge

Education

High School/GED

Bachelor's in Nursing

Tools

Electronic Health Records

Case management software

Microsoft Office

Job description

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management for members, developing care plans and coordinating services to promote optimal health outcomes while containing costs.

The role requires extensive clinical knowledge with five years of related experience, RN licensure, and CCM certification within 36 months. Remote position with occasional travel and collaboration with physicians and providers.