Senior RN Case Manager — Remote Care Leader

Highmark Health; Guin (AL); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services to members, coordinating care plans and resources to promote quality, cost-effective outcomes.

The role requires 5 years of relevant experience, RN licensure or multi-state eNLC, CCM certification within 36 months, and the ability to work with diverse populations. This position may be office-based or remote with travel less than 25%.

Qualifications

• 5 years in clinical, case/utilization management, or health insurance experience.
• RN licensure required (state or multi-state eNLC).
• CCM certification must be obtained within 36 months of hire.

Responsibilities

• Manage caseloads of members with complex health needs and coordinate care plans.
• Assess health status, needs, and resources; develop individualized care plans with members and providers.
• Coordinate services and monitor progress toward goals; adjust plans as needed.
• Act as advocate and liaison to meet members' health care needs, ensuring quality, cost-effective outcomes.
• Document all activities in compliance with policies and regulatory standards.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

EHR proficiency

Healthcare systems

Education

High School/GED

Bachelor's in Nursing

RN licensure

CCM certification (within 36 months of hire)

OCN/CPON/CNN certifications

Job description

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services to members, coordinating care plans and resources to promote quality, cost-effective outcomes.

The role requires 5 years of relevant experience, RN licensure or multi-state eNLC, CCM certification within 36 months, and the ability to work with diverse populations. This position may be office-based or remote with travel less than 25%.