Senior RN Case Manager | Remote Care Leader

Highmark Health; Muncie (IN); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a Case Manager to provide comprehensive case management services, coordinating care plans and provider communications to promote optimal health outcomes for members in a cost-conscious manner.

Responsibilities include assessing needs, developing complex care plans, monitoring progress, and serving as an advocate within a HIPAA-compliant framework. Requires 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.
• Preferred: transplant-specific clinical experience
• Experience working with diverse populations
• Advanced training in CBT, motivational interviewing, or DBT

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 and liaison to meet a member's health care needs and ensure quality, cost-effective outcomes.
• Document activities in compliance with policies and procedures.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

Negotiation

Education

High School/GED

Bachelor's in Nursing (preferred)

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 plans and provider communications to promote optimal health outcomes for members in a cost-conscious manner.

Responsibilities include assessing needs, developing complex care plans, monitoring progress, and serving as an advocate within a HIPAA-compliant framework. Requires RN licensure and CCM certification within 36 months of hire.