Complex Case Manager RN - Remote

About the Role

The Complex Case Manager RN serves as the primary owner and overseer of a specified panel of members with varying health statuses and clinical needs. This role is designed to bridge clinical expertise with data-driven decision-making to optimize patient outcomes.

In this remote position, you will utilize professional clinical judgment alongside advanced analytics to identify the most appropriate clinical interventions for each member. Supported by a multi-disciplinary team, you will manage an active caseload of members enrolled in case management, conducting outreach to develop care plans, encourage behavior changes, and address barriers to care. Your goal is to coordinate care effectively, helping members achieve their personal health goals while monitoring and improving clinical, financial, and functional quality outcomes.

Who You Are

We are looking for a dedicated healthcare professional with a strong background in clinical case management. You bring at least 7 years of experience in clinical, case management, disease/condition management, provider operations, or health insurance. You hold a current RN license in Pennsylvania, or through the enhanced Nurse Licensure Compact (eNLC), or in West Virginia, Delaware, or New York. Other applicable RN licenses must be obtained within the first 6 months of employment.

A Bachelor's Degree in Nursing is preferred, along with certification in Case Management. You possess a broad knowledge of disease processes and a deep understanding of healthcare costs and service delivery systems. Your skill set includes strong analytic abilities, proficiency in MS Excel, and the capacity to interpret and act on clinical and financial data.

You are a self-directed self-starter who thrives in a high-performing team environment. You demonstrate excellent organizational, time management, and project management skills, with the ability to handle multiple priorities in a fast-paced environment. Your interpersonal skills allow you to positively influence others with respect and compassion, while building consensus with internal and external colleagues at all levels.

Why Join Highmark

At Highmark, we are committed to providing accessible, affordable, and quality healthcare. We believe in the power of our people to make a difference in the lives of our members and communities. Our culture is built on integrity, collaboration, and a shared mission to improve health and well-being.

Equal Opportunity Employer

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

Compliance and Privacy

All employees must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA), as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct, including adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.