Senior RN Case Manager - Remote Care Navigator

Highmark Health; Trenton (NJ); Híbrido; USD 79 000 - 127 000; Tempo integral

Resumo da oferta

Highmark Inc. in New Jersey seeks a seasoned Case Manager to deliver comprehensive case management services to members, coordinating care to promote optimal health outcomes while containing costs.

You will assess needs, develop care plans, and monitor progress to ensure timely access to services. This office-based or remote role requires 5 years of clinical or utilization management experience, current RN licensure (eNLC acceptable), and CCM certification within 36 months of hire.

Qualificações

• 5 years in clinical, case/utilization management, disease condition management, or health-insurance operations.
• Current State RN licensure OR multi-state licensure via eNLC.
• CCM certification must be obtained within 36 months of hire (exempt for incumbents as of Aug 2026).

Responsabilidades

• Manage a caseload of members with complex health needs requiring advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs, and available resources.
• Coordinate care plans with members, physicians, and other providers.
• Monitor progress and adjust care plans to achieve goals.
• Document activities in accordance with policy and standards.

Conhecimentos

Clinical assessment

Leadership

Advocacy

EHR proficiency

Healthcare knowledge

Formação académica

High School/GED

Bachelors in Nursing

Ferramentas

Microsoft Office

Case management software

Electronic health records

Descrição da oferta de emprego

Highmark Inc. in New Jersey seeks a seasoned Case Manager to deliver comprehensive case management services to members, coordinating care to promote optimal health outcomes while containing costs.

You will assess needs, develop care plans, and monitor progress to ensure timely access to services. This office-based or remote role requires 5 years of clinical or utilization management experience, current RN licensure (eNLC acceptable), and CCM certification within 36 months of hire.