Senior RN Case Manager – Remote Care Leadership

Highmark Health; Boise (ID); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor progress. The role emphasizes cost-effective care delivery and collaboration with physicians and providers to ensure quality outcomes.

The position requires 5 years of relevant experience, RN licensure, CCM certification within 36 months, and strong knowledge of healthcare systems. Remote or office-based work is possible with travel <25%.

Qualifications

• 5 years in clinical, case/utilization management, disease management, or health insurance.
• RN licensure with CCM certification to be obtained within 36 months (exemption for current holders).
• Knowledge of CBT/MBI/DBT is a plus and preference for transplant experience.

Responsibilities

• Manage a caseload of members with complex health needs and coordinate care.
• Develop and implement individualized care plans with providers and members.
• Assess health status, needs and resources; monitor progress toward goals.
• Advocate for members and ensure documentation complies with policies and standards.
• Mentor lower-level Case Managers and collaborate with the health team.

Skills

Clinical assessment

Care planning

Leadership

Negotiation

EHR proficiency

Healthcare systems knowledge

Education

High School/GED

Bachelors in Nursing

Tools

Microsoft Office

Case Management Software

Electronic Health Records (EHR)

Job description

Highmark Health is seeking a Case Manager to provide comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor progress. The role emphasizes cost-effective care delivery and collaboration with physicians and providers to ensure quality outcomes.

The position requires 5 years of relevant experience, RN licensure, CCM certification within 36 months, and strong knowledge of healthcare systems. Remote or office-based work is possible with travel <25%.