Medical Case Manager

Highmark Health

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

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

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing complex health needs through individualized care planning, assessment, and coordination of healthcare services. Proficient in compliance with regulatory requirements and advocating for diverse populations.

Highest-signal resume keywords

RN LicensureCase Management ExperienceAssessment And Care Planning SkillsProficiency In Microsoft Office SuiteCertified Case Manager (CCM)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care PlanningHealth AssessmentUtilization ManagementCultural CompetencyHealthcare Systems Understanding

Soft Skills

Team CollaborationIndependent Work AbilityAdvocacy Skills

Tools & Technologies

Case Management SoftwareElectronic Health Records

Certifications & Qualifications

Licensed Certified Social WorkerCertified Case Manager (CCM)

Industry Keywords

Medicaid Managed CareMedicare ExperienceDiverse Populations Healthcare Needs

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 and implement individualized care plans with members, physicians, and healthcare providers
Coordinate care plans, referrals to specialists, community resources, services, and appropriate healthcare resources
Monitor member progress toward goals 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
Work collaboratively with physicians, providers, coworkers, and other healthcare team members
Document activities in compliance with business processes, company policies, regulatory requirements, and accreditation standards
Identify opportunities for cost savings, quality improvement, and workflow efficiencies
Detect, resolve, and prevent improper utilization of member benefits
Perform other duties as assigned or requested

Requirements

What you’ll need

3 years of experience in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience with RN licensure or a Master’s degree OR 5 years’ experience with a Bachelor’s in Social Work
Bachelor’s degree in nursing or RN licensure or Master’s degree in Social Work, Counseling, or related field OR Bachelor’s degree in Social Work
Required licensure: LSW, LPC, LBSW, LCSW, LMSW, LGSW, Licensed Certified Social Worker, current State RN licensure, or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
Incumbents in the role prior to 1/1/25 who are not currently licensed must obtain licensure by 12/31/27
Strong assessment and care planning skills
Ability to work independently and as part of a team
Proficiency in Microsoft Office suite, case management software, and electronic health records
Understanding of healthcare systems and case management principles
Medicaid managed care and/or Medicare experience preferred
Experience working with the healthcare needs of diverse populations preferred
Experience demonstrating understanding of cultural competency preferred
Bilingual English/Spanish language skills preferred
Certified Case Manager (CCM) preferred
Travel required: 0%–25%