Case Manager, RN

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $72.7k - $116.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 $5M Grant on 2021-05

Insurance • Consulting • Logistics

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Manage a caseload of members with moderate complexity health needs • Assess members’ health status, needs, and available resources • Develop individualized care plans with members, physicians, and healthcare providers • Implement and coordinate care plans and access to appropriate services and resources • Coordinate referrals to specialists and community resources • Monitor member progress and adjust care plans as needed • Evaluate the effectiveness of interventions and services • Advocate and act as a liaison for members’ individual healthcare needs • Communicate and collaborate with physicians, providers, coworkers, and healthcare team members • Document activities in compliance with business processes, company policies, regulatory requirements, and accreditation standards • Identify potential cost savings, quality improvements, and workflow efficiencies • Detect, resolve, and prevent improper utilization of member benefits • Perform other duties as assigned or requested

🎯 Requirements

• High School Diploma/GED • 3 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience • Current State of PA RN licensure OR current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV, DE, or NY • Other RN license(s), if applicable, must be obtained within the first 6 months of employment • Experience working with the healthcare needs of diverse populations • Experience demonstrating understanding of the importance of cultural competency in addressing targeted populations • Strong assessment and care planning skills • Ability to work independently and as part of a team • Proficiency in Microsoft suite of applications, case management software, and electronic health records • Understanding of healthcare systems and case management principles • Compliance with HIPAA, data security guidelines, company policies, legal requirements, and accreditation standards

🏖️ Benefits

• Remote work arrangement • Travel requirement of 0%–25%