Senior RN Case Manager — Remote Care Leader

Highmark Health; Williamstown (NJ); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a Case Manager to deliver comprehensive case management services for members, coordinating care plans and monitoring progress to promote quality and cost-effective outcomes. Responsibilities include assessments, care planning, and collaboration with physicians and teams to ensure appropriate service access.

The role requires 5 years of relevant experience, active RN licensure or eNLC, 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, or provider operations and/or health insurance experience.
• Current State RN licensure OR Current multi-state licensure through eNLC.
• Certified Case Manager (CCM) must be obtained within 36 months of hire (exempt for incumbents as of August 2026).
• Transplant specific clinical experience is preferred.
• Experience with diverse populations and cultural competency is preferred.
• Advanced training in CBT, motivational interviewing, or DBT is preferred.

Responsibilities

• Manage a caseload of members with complex health needs, requiring advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Advocate and liaise to meet members’ health care needs using available resources.
• Collaborate with physicians, providers, and the health care team to carry out the plan of care.
• Ensure documentation adheres to policies, regulations, and compliance standards.
• Provide guidance and mentorship to lower-level Case Managers.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

EHR / Microsoft Office

Healthcare systems knowledge

Education

High School/GED

Bachelor's in Nursing (preferred)

Job description

Highmark Health is seeking a Case Manager to deliver comprehensive case management services for members, coordinating care plans and monitoring progress to promote quality and cost-effective outcomes. Responsibilities include assessments, care planning, and collaboration with physicians and teams to ensure appropriate service access.

The role requires 5 years of relevant experience, active RN licensure or eNLC, and CCM certification within 36 months of hire.