Senior RN Case Manager: Remote Complex Care & Advocacy

Highmark Health; Bastrop (LA); Remote; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a Case Manager to deliver comprehensive, cost-conscious care management for members with complex needs. You will assess, plan, implement, and monitor care while coordinating with physicians and providers to optimize outcomes.

The role emphasizes adherence to HIPAA, use of EHRs, and ongoing professional development, including supervision of junior staff and adherence to contract benefits.

Qualifications

• At least five years in clinical or utilization management roles with health insurance experience.
• Experience with diverse populations and healthcare needs.
• Advanced training in CBT, motivational interviewing, or DBT.
• Expertise in clinical assessment and care planning.
• Proficiency with Microsoft Office, case management software and EHR systems.

Responsibilities

• Manage a caseload of members with complex health needs and coordinate care.
• Conduct comprehensive assessments and develop complex care plans.
• Implement, monitor and adjust care plans to achieve goals.
• Collaborate with physicians and providers to ensure access to services.
• Document activities in compliance with policies and regulations.
• Provide guidance and mentorship to lower-level Case Managers.

Skills

Clinical knowledge

Communication

Documentation

Mentorship

Problem solving

Microsoft Office

Case management software

Electronic Health Records

Education

Bachelor's in Nursing

RN licensure

CCM certification within 36 months

eNLC multi-state licensure

Tools

Case management software

Microsoft Office

Electronic Health Records (EHR)

Job description

Highmark Health is seeking a Case Manager to deliver comprehensive, cost-conscious care management for members with complex needs. You will assess, plan, implement, and monitor care while coordinating with physicians and providers to optimize outcomes.

The role emphasizes adherence to HIPAA, use of EHRs, and ongoing professional development, including supervision of junior staff and adherence to contract benefits.