Senior RN Case Manager — Remote Care Leader

Highmark Health; Clayton (NM); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, develop care plans, coordinate services, and monitor outcomes.

The role emphasizes containing healthcare costs while promoting high-quality care and adherence to regulatory and contractual requirements. The incumbent will assess needs, collaborate with physicians and providers, mentor junior staff, and ensure documentation complies with HIPAA and company policies.

Qualifications

• 5+ years in clinical, case/utilization management, or disease condition management experience.
• RN licensure current (state or eNLC)
• CCM certification to be obtained within 36 months of hire (exemption for incumbents)

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Coordinate services and monitor progress toward goals.
• Advocate for members and ensure cost-effective care.
• Document activities in compliance with policies and regulations.

Skills

Clinical assessment

Leadership & mentoring

Negotiation & advocacy

MS Office / EHR proficiency

Healthcare systems & case management

Education

High School or GED

Bachelor's in Nursing

Tools

Microsoft Office

Electronic Health Records

Case management software

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, develop care plans, coordinate services, and monitor outcomes.

The role emphasizes containing healthcare costs while promoting high-quality care and adherence to regulatory and contractual requirements. The incumbent will assess needs, collaborate with physicians and providers, mentor junior staff, and ensure documentation complies with HIPAA and company policies.