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, severities, and clinical needs. This role is designed to bridge clinical expertise with data-driven insights to optimize patient outcomes. By utilizing professional clinical judgment alongside analytics, the incumbent identifies the most appropriate clinical interventions for each member.

Supported by a multi-disciplinary team, the Case Manager plays a pivotal role in managing an active caseload of members enrolled in case management. The position involves conducting comprehensive outreach, developing personalized care plans, and encouraging behavior changes to help members achieve their personal health goals. The incumbent is to monitor, improve, and maintain quality outcomes—clinical, financial, and functional—for the assigned panel.

Why This Role Matters

In the complex landscape of healthcare, effective case management is essential for addressing barriers to care and ensuring members receive the right support at the right time. This role exists to provide high-touch, compassionate care coordination that improves health outcomes while navigating the broader healthcare service delivery system. The Case Manager acts as a liaison between members, providers, and resources, ensuring that care is not only delivered but is also accessible and effective.

Culture and Compliance

Highmark Health is committed to fostering an inclusive environment where every employee can thrive. We prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and we prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

As a member of our team, you will adhere to the ethical and legal standards and behavioral expectations set forth in the Code of Business Conduct. You will also play a critical role in protecting confidential customer information, complying with HIPAA regulations, and following all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices.

Application and Accommodation

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