Senior RN Case Manager - Remote Care Leader

Highmark Health; Nebraska; Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking an experienced Case Manager to deliver comprehensive disease management and care coordination for members.

You will assess needs, develop and implement care plans, coordinate services, and monitor progress to promote quality, cost-effective outcomes in line with contract benefits. The role requires 5 years of clinical or utilization management experience; RN licensure (or multi-state via eNLC) and CCM certification within 36 months.

Qualifications

• 5 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.
• Preferred: transplant-specific clinical experience and cultural competency in diverse populations.
• Advanced training in CBT, motivational interviewing or DBT is a plus.

Responsibilities

• Manage a caseload of members with complex health needs and advanced clinical requirements.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs and resources of members.
• Collaborate with members, physicians and other providers to implement individualized care plans.
• Coordinate access to services and monitor progress toward goals.
• Evaluate intervention effectiveness and adjust plans as needed.
• Advocate for members and document activities per policies and accreditation standards.
• Mentor lower-level Case Managers and provide clinical expertise as needed.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

Microsoft Office

Case management software

Electronic health records

Education

High School/GED

Bachelors in Nursing

Tools

Electronic Health Records

Case management software

Job description

Highmark Inc. is seeking an experienced Case Manager to deliver comprehensive disease management and care coordination for members.

You will assess needs, develop and implement care plans, coordinate services, and monitor progress to promote quality, cost-effective outcomes in line with contract benefits. The role requires 5 years of clinical or utilization management experience; RN licensure (or multi-state via eNLC) and CCM certification within 36 months.