Case Manager, RN

Highmark Health

. Manage a caseload of members with moderate complexity health needs .

Posted 10/1/2026full-timeRemote • Pennsylvania • United StatesMid-LevelSenior💰 $72,700 - $116,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong assessment and care planning skills while effectively managing a caseload of members with moderate complexity health needs. Proficient in coordinating care plans, collaborating with healthcare providers, and ensuring compliance with regulatory requirements.

Highest-signal resume keywords

RN LicensureCase ManagementCare PlanningHealthcare Systems UnderstandingCultural Competency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Assessment SkillsCare Planning SkillsClinical ManagementUtilization ManagementDisease Condition ManagementProvider OperationsHealth Insurance ExperienceElectronic Health RecordsCase Management SoftwareDocumentation Compliance

Soft Skills

Independent WorkTeam CollaborationAdvocacyCommunication

Tools & Technologies

Microsoft SuiteCase Management SoftwareElectronic Health Records

Certifications & Qualifications

High School Diploma/GEDCurrent State of PA RN LicensureMulti-State Licensure through eNLC

Industry Keywords

Healthcare NeedsModerate Complexity Health NeedsQuality ImprovementsWorkflow EfficienciesCultural Competency

About the role

Key responsibilities & impact

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 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 to meet 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

What you’ll need

High School Diploma/GED required
3 years in any combination of clinical, case/utilization management, disease condition management, 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 required
Other RN license(s), if applicable, must be obtained within the first 6 months of employment
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
Bachelor's Degree in Nursing preferred
Experience working with the healthcare needs of diverse populations preferred
Experience demonstrating understanding of cultural competency in addressing targeted populations preferred

Benefits

Comp & perks

Remote work arrangement
Travel requirement of 0%–25%