Senior RN Case Manager — Remote/Hybrid Care Coordination

Highmark Health; Maryland; Hybrid; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a Case Manager to deliver comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor progress to ensure quality, cost-effective care. This role emphasizes collaboration with physicians and providers and compliance with all policies and HIPAA requirements.

The position requires RN licensure (state or eNLC), advanced clinical knowledge, and CCM certification within 36 months.

Qualifications

• Active RN licensure (state) or multi-state eNLC.
• CCM certification to be obtained within 36 months of hire.
• Experience with CBT/DBT or motivational interviewing is preferred.
• Proficiency with case management software and EHR systems.
• Strong understanding of healthcare systems and case management principles.

Responsibilities

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess health status, needs and available resources of members.
• Coordinate and implement care plans with members, physicians and providers.
• Document activities in compliance with policies and regulatory standards.
• Provide guidance and mentorship to lower-level Case Managers.
• Collaborate with the care team to carry out the plan of care.
• Monitor progress and adjust plans to achieve optimal outcomes.

Skills

Clinical assessment

Care planning

Communication

EHR

Case management software

Team collaboration

Education

Bachelor of Science in Nursing

RN licensure (state or eNLC)

Tools

Case management software

Electronic Health Records

Microsoft Office

Job description

Highmark Health is seeking a Case Manager to deliver comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor progress to ensure quality, cost-effective care. This role emphasizes collaboration with physicians and providers and compliance with all policies and HIPAA requirements.

The position requires RN licensure (state or eNLC), advanced clinical knowledge, and CCM certification within 36 months.