Senior RN Case Manager — Remote Care Leadership

Highmark Health; Annapolis (MD); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. seeks a Case Manager to deliver comprehensive care management for members with complex health needs, focusing on cost-effective, quality outcomes and care coordination across providers. The role involves assessments, care planning, monitoring progress, advocating for members, and mentoring junior staff.

RN licensure and CCM certification within 36 months are required. The position supports collaborative work with physicians and care teams, ensuring compliant documentation and

Qualifications

• 5 years in 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 the enhanced Nurse Licensure Compact (eNLC).
• CCM certification must be obtained within 36 months of hire; incumbents as of Aug 2026 are exempt.

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.
• Act as an advocate and liaison to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services.
• Work collaboratively and communicate clearly and professionally with physicians, providers, co-workers and other members of the health care team to carry out the established plan of care.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements, company policies, regulatory requirements and accreditation standards.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.
• Other duties as assigned or requested.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

EHR systems

Education

High School/GED

Bachelors in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records (EHR)

Job description

Highmark Inc. seeks a Case Manager to deliver comprehensive care management for members with complex health needs, focusing on cost-effective, quality outcomes and care coordination across providers. The role involves assessments, care planning, monitoring progress, advocating for members, and mentoring junior staff.

RN licensure and CCM certification within 36 months are required. The position supports collaborative work with physicians and care teams, ensuring compliant documentation and