Case Manager, RN

Highmark Health

. Provide comprehensive case management services to members .

Posted 11/5/2026full-timeRemote • United StatesMid-LevelSenior💰 $72,700 - $116,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management, including assessment, care planning, and coordination of services for members with moderate complexity health needs. Proficient in utilizing healthcare systems and case management software to ensure compliance and improve member outcomes.

Highest-signal resume keywords

Case ManagementAssessment SkillsCare PlanningRN LicensureHealthcare Systems Understanding

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementAssessment SkillsCare PlanningHealthcare Systems UnderstandingUtilization ManagementElectronic Health RecordsClinical ExperienceDisease Condition ManagementProvider OperationsQuality Improvement

Soft Skills

AdvocacyCollaborationCommunicationIndependent WorkTeamwork

Tools & Technologies

Microsoft SuiteCase Management SoftwareElectronic Health Records

Certifications & Qualifications

RN LicensureMulti-State Licensure (eNLC)

Industry Keywords

HealthcareCultural CompetencyDiverse PopulationsRegulatory ComplianceAccreditation Standards

About the role

Key responsibilities & impact

Provide comprehensive case management services to members
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 other healthcare providers
Implement and coordinate care plans and ensure 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
Act as an advocate and liaison to meet members’ individual healthcare needs
Collaborate and communicate 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

What you’ll need

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 or DE or NY
Other RN license(s), if applicable, must be obtained within the first 6 months of employment
Proficiency in using Microsoft suite of applications, case management software and electronic health records
Strong assessment and care planning skills
Understanding of healthcare systems and case management principles
Ability to work independently and as part of a team
Preferred: Bachelor's Degree in Nursing
Preferred: Experience working with the healthcare needs of diverse populations
Preferred: Experience demonstrating understanding of the importance of cultural competency in addressing targeted populations
Language requirement other than English: None
Travel requirement: 0% - 25%