Senior RN Case Manager – Remote Complex Care Leader

Highmark Health; Arizona; Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services, coordinating care for members with complex health needs and helping contain costs through effective utilization management.

The role requires a state RN license (or multi-state eNLC) and CCM certification within 36 months. Office-based or remote work options are available, with travel <25% and a focus on collaboration with clinicians and providers.

Qualifications

• Requires 5 years in clinical, case/utilization management, disease condition management, or related health insurance operations.
• RN licensure (state) or multi-state licensure via eNLC required.
• CCM certification must be obtained within 36 months of hire (exempt for current staff as of Aug 2026).
• Experience with diverse populations and cultural competency is preferred.

Responsibilities

• Manage a caseload of members with complex health needs and advanced clinical requirements.
• Conduct comprehensive assessments and develop complex care plans with physicians and providers.
• Coordinate services and monitor progress toward goals, adjusting plans as needed.
• Advocate for members and ensure documentation aligns with contracts, policies and accreditation standards.
• Mentor and provide guidance to lower-level case managers and collaborate with health care team.

Skills

Clinical assessment

Care planning

Leadership & mentoring

Negotiation & advocacy

MS Office

Case management software

Electronic health records

Healthcare systems knowledge

Education

High School/GED

Bachelor's in Nursing

Tools

Microsoft Office

Electronic Health Records

Case Management Software

Job description

Highmark Health is seeking an experienced Case Manager to provide comprehensive case management services, coordinating care for members with complex health needs and helping contain costs through effective utilization management.

The role requires a state RN license (or multi-state eNLC) and CCM certification within 36 months. Office-based or remote work options are available, with travel <25% and a focus on collaboration with clinicians and providers.