Specialist Case Manager RN
New
H
Highmark Inc.Health Insurance
United StatesFull-TimeSenior
Salary86,400 - 138,600 USD per year
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Job Details
- Experience
- 7 years of experience in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience
- Required Skills
- Generative AIEHR
Requirements
- 7 years of experience in clinical, case/utilization management, disease condition management, provider operations, or health insurance.
- Bachelor’s degree in Nursing (or equivalent education/experience).
- Current State RN licensure or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
- Certified Case Manager (CCM) certification must be obtained within 36 months of hire.
- In-depth knowledge of specialized clinical areas and emerging treatments.
- Expertise in navigating complex healthcare systems and resources.
- Strong analytical and problem-solving skills.
- Strong proficiency in Microsoft suite, case management software, and electronic health records.
- Excellent communication and presentation skills.
- Ability to interpret data and make data-based recommendations.
- Skill in using generative AI.
Responsibilities
- Provide case management services to members with highly complex or specialized needs.
- Perform ongoing assessments of member health management needs and identify appropriate clinical interventions.
- Develop and implement innovative strategies to improve outcomes and reduce costs for specialized populations.
- Develop individualized care plans in collaboration with members, physicians, and healthcare providers.
- Monitor member progress toward goals and adjust care plans as needed.
- Act as an advocate and liaison to meet individual member healthcare needs.
- Ensure all activities are documented in compliance with business processes and regulatory requirements.
- Serve as a subject matter expert and provide training to other case managers.
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