Senior RN Case Manager - Remote Care Leader

Highmark Health; Augusta (ME); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a skilled Case Manager to provide comprehensive case management services, assess member needs, develop and implement care plans, and coordinate access to services while containing costs.

The role emphasizes collaboration with physicians, care teams, and members to improve health outcomes. The position requires5 years of experience in case management or related fields, RN licensure, and CCM certification within 36 months of hire.

Qualifications

• 5 years in any combination of clinical, case/utilization management, and/or disease condition management experience.
• RN licensure in state or multi-state via eNLC.
• CCM certification must be obtained within 36 months of hire (exempt for incumbents as of Aug 2026).

Responsibilities

• Manage a caseload of members with complex health needs and coordinate care plans.
• Conduct comprehensive assessments and develop complex care plans.
• Monitor progress and adjust plans to achieve goals.
• Advocate for members and coordinate with physicians and providers.

Skills

Clinical assessment

Leadership

Negotiation

EHR systems

MS Office

Healthcare systems

Education

High School/GED

Bachelor’s in Nursing

Tools

Case management software

Electronic Health Records

Job description

Highmark Inc. is seeking a skilled Case Manager to provide comprehensive case management services, assess member needs, develop and implement care plans, and coordinate access to services while containing costs.

The role emphasizes collaboration with physicians, care teams, and members to improve health outcomes. The position requires5 years of experience in case management or related fields, RN licensure, and CCM certification within 36 months of hire.