Senior RN Case Manager — Remote Care Navigator

Highmark Health; Fulton (MS); Remote; USD 114.000 - 140.000; Vollzeit

Zusammenfassung

Highmark Health is seeking a Case Manager to provide comprehensive case management for members with complex health needs. You will assess needs, develop and coordinate care plans, and monitor progress to promote quality, cost-effective outcomes.

The role requires advanced clinical knowledge, collaboration with physicians and the care team, and adherence to HIPAA and company policies. A CCM is preferred and RN licensure is required.

Qualifikationen

• 5 years in clinical, case/utilization management, or related health-insurance roles.
• Experience with diverse populations.
• Advanced training in CBT, motivational interviewing, or DBT.
• Expertise in clinical assessment and care planning.
• Proficiency with MS Office and EHR systems.

Aufgaben

• 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 providers.
• Implement and coordinate care plans, ensuring access to services and resources.
• Monitor progress toward goals and adjust care plans as needed.
• Advocate and liaise to meet health care needs using available resources and benefits.
• Collaborate with physicians, providers, and the health care team to carry out the plan.
• Ensure all activities are documented in compliance with policies and regulations.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.

Kenntnisse

CBT

Motivational Interviewing

DBT

Ausbildung

Bachelors in Nursing

RN license or eNLC

CCM certification within 36 months

Tools

Case management software

Electronic health records

Microsoft Office

Jobbeschreibung

Highmark Health is seeking a Case Manager to provide comprehensive case management for members with complex health needs. You will assess needs, develop and coordinate care plans, and monitor progress to promote quality, cost-effective outcomes.

The role requires advanced clinical knowledge, collaboration with physicians and the care team, and adherence to HIPAA and company policies. A CCM is preferred and RN licensure is required.