Senior Case Manager RN; Remote

About This Role

The Senior Case Manager RN is responsible for providing comprehensive case management services to members, ensuring quality and cost-effective care delivery while promoting optimal health outcomes. This role is ideal for experienced nurses with advanced clinical knowledge and strong leadership skills.

• Pay: $79,300 - $127,100/year
• Location: Pa, US
• Schedule: Full-time

• Manage a caseload of members with complex health needs.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• 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 and communicate clearly with healthcare team members.
• Ensure all activities are documented in compliance with applicable requirements.

Education:

• High School/GED required
• Bachelor’s in Nursing preferred

Experience:

• 5 years in clinical, case/utilization management, and/or disease condition management experience required
• Specialty specific clinical experience preferred

Licenses &

Certifications:

• Current State RN licensure or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) required
• 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 ensuring quality and cost-effective healthcare solutions for their members while promoting optimal health outcomes.