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Highmark HealthPosted 10/21/2026full-timeRemote • Pennsylvania • United StatesMid-LevelSenior💰 $72,700 - $116,600 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong assessment and care planning skills while managing a caseload of members with moderate complexity health needs. Proficient in coordinating care plans, advocating for members, and ensuring compliance with healthcare regulations and standards.
Highest-signal resume keywords
RN LicensureCase Management ExperienceCultural CompetencyAssessment SkillsCare Planning
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 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
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, 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
Comp & perks- Remote work arrangement
- Travel requirement of 0%–25%
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Assessment SkillsCare PlanningCase ManagementUtilization ManagementDisease Condition ManagementHealthcare Systems UnderstandingRegulatory ComplianceQuality ImprovementCost Savings IdentificationWorkflow Efficiency
Soft Skills
CommunicationCollaborationAdvocacyIndependenceTeamwork
Tools & Technologies
Microsoft SuiteCase Management SoftwareElectronic Health Records
Certifications & Qualifications
Current State of PA RN LicensureMulti-State Licensure through eNLC
Industry Keywords
Healthcare NeedsDiverse PopulationsCultural CompetencyHIPAA ComplianceAccreditation Standards