Specialist Case Manager RN - (Remote)

IntelliResume; Pennsylvania; Hybrid; USD 86,000 - 139,000; Full time

Job summary

Highmark Health is seeking a Specialist Case Manager RN to provide comprehensive case management for members, ensuring quality, cost-effective care and optimal health outcomes in Pennsylvania.

You will oversee a panel of members, develop individualized care plans with members and clinicians, coordinate services, advocate for patients, and collaborate with physicians and the healthcare team to improve outcomes.

Qualifications

• Bachelor’s degree in Nursing or relevant experience and/or education in lieu of a bachelor’s degree.
• 7 years of experience in clinical, case/utilization management, and/or disease condition management.
• Current State RN licensure or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
• Certified Case Manager (CCM) certification must be obtained within 36 months of hire.

Responsibilities

• Provide case management services to members with complex needs.
• Maintain oversight over a specified panel of members.
• Develop and implement innovative strategies to improve outcomes and reduce costs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members and healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet a member's health care needs.
• Work collaboratively with physicians, providers, and other members of the healthcare team.

Skills

Clinical case management

Care coordination

Advocacy

Collaboration with physicians

Education

Bachelor’s degree in Nursing

CCM certification within 36 months

Job description

About This Role

The Specialist Case Manager RN is responsible for providing comprehensive case management services to members, ensuring quality, cost-effective care delivery, and promoting optimal health outcomes. This role is ideal for experienced nurses with a strong background in clinical and case management.

Highlights

• Pay: $86,400 - $138,600/year
• Location: Pa, US
• Schedule: Full-time

What You'll Do

• Provide case management services to members with complex needs.
• Maintain oversight over a specified panel of members.
• Develop and implement innovative strategies to improve outcomes and reduce costs.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members and healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services.
• Monitor member progress toward goals and adjust care plans as needed.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet a member's individual health care needs.
• Work collaboratively with physicians, providers, and other members of the healthcare team.

Requirements

Education:

• Bachelor’s degree in Nursing or relevant experience and/or education in lieu of a bachelor’s degree.

Experience:

• 7 years of experience in clinical, case/utilization management, and/or disease condition management.

Licenses & Certifications:

• Current State RN licensure or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
• Certified Case Manager (CCM) certification must be obtained within 36 months of hire.

About Highmark Health

Highmark Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on innovative solutions to improve health outcomes and ensure cost-effective services for their members.