Senior Case Manager RN
New
H
Highmark Inc.Healthcare
United StatesFull-TimeSenior
Salary79,300 - 127,100 USD per year
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Job Details
- Experience
- 5 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.
- Required Skills
- LeadershipMicrosoft OfficeEHR
Requirements
- 5 years in any combination of clinical, case/utilization management, disease condition management, provider operations, or health insurance experience.
- 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.
- High School/GED required; Bachelor's in Nursing preferred.
- Expertise in clinical assessment and care planning.
- Strong leadership and mentoring skills.
- Excellent negotiation and advocacy skills.
- Proficiency in Microsoft suite, case management software, and electronic health records.
- Strong understanding of healthcare systems and case management principles.
Responsibilities
- Manage a caseload of members with complex health needs, requiring advanced clinical knowledge.
- 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 physicians, providers, co-workers and the health care team.
- Provide guidance and mentorship to lower-level Case Managers.
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