Senior RN Case Manager — Remote Care Navigator

Highmark Health; California City (CA); Remote; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking a skilled Case Manager to deliver comprehensive case management services for members, coordinate care plans, and promote quality, cost-effective outcomes within contract benefits.

The role requires at least 5 years of clinical or utilization management experience, RN licensure (or multi-state via eNLC), CCM certification within 36 months, and strong collaboration with physicians and providers. Travel less than 25%.

Qualifications

• 5 years in any combination of clinical, case/utilization management, and/or disease condition management experience.
• Experience with diverse populations and culture competency is preferred.
• Advanced training in CBT, motivational interviewing, or DBT is a plus.
• Transplant-specific clinical experience is preferred.

Responsibilities

• Manage a caseload of members with complex health needs.
• 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 services and resources.
• Monitor progress and adjust care plans as needed.
• Evaluate interventions for effectiveness.
• Act as an advocate and liaison to meet member health care needs.
• Coordinate with physicians and providers to carry out the plan of care.
• Ensure activities documented in compliance with policies and regulations.

Skills

Clinical assessment

Care planning

Leadership

Advocacy

EHR software

Healthcare systems

Education

High School/GED

Bachelors in Nursing

Tools

MS Office

Case management software

EHR systems

Job description

Highmark Inc. is seeking a skilled Case Manager to deliver comprehensive case management services for members, coordinate care plans, and promote quality, cost-effective outcomes within contract benefits.

The role requires at least 5 years of clinical or utilization management experience, RN licensure (or multi-state via eNLC), CCM certification within 36 months, and strong collaboration with physicians and providers. Travel less than 25%.