Specialist Case Manager RN Remote

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.

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

• 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.

• 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.

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.