Senior RN Case Manager - Remote | Lead Care Coordination

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

Job summary

Highmark Inc. is seeking an experienced Case Manager to deliver comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor progress to ensure quality and cost-effective health outcomes.

The role requires strong clinical knowledge and RN licensure (or multi-state eNLC), with CCM certification to be obtained within 36 months of hire. Office-based or remote work options may be available to support flexible work arrangements.

Qualifications

• 5 years in clinical, case/utilization management, or disease condition management and/or health insurance.
• RN licensure in state or multi-state eNLC licensure.
• CCM certification must be obtained within 36 months of hire (exempt for August 2026 hires).

Responsibilities

• Manage a caseload of members with complex health needs and coordinate care plans.
• Conduct comprehensive assessments and develop individualized care plans.
• Collaborate with physicians and providers to implement care plans.
• Monitor progress, evaluate interventions, and document activities in compliance with policies.
• Provide guidance and mentorship to junior Case Managers.

Skills

Clinical assessment

Care planning

Leadership

Mentoring

Negotiation

EHR proficiency

Healthcare systems knowledge

Education

High School/GED

Bachelor's in Nursing

Tools

Microsoft Office

Case management software

Electronic Health Records (EHR)

Job description

Highmark Inc. is seeking an experienced Case Manager to deliver comprehensive case management services, assess member needs, develop and coordinate care plans, and monitor progress to ensure quality and cost-effective health outcomes.

The role requires strong clinical knowledge and RN licensure (or multi-state eNLC), with CCM certification to be obtained within 36 months of hire. Office-based or remote work options may be available to support flexible work arrangements.