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, effective communication with healthcare teams, and compliance with regulatory standards. Proficient in case management principles and skilled in assessing and advocating for diverse populations.

Highest-signal resume keywords

Licensed Social Worker (LSW)Case Management SoftwareElectronic Health RecordsAssessment and Care PlanningMedicaid Managed Care Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ManagementUtilization ManagementDisease Condition ManagementCare Plan DevelopmentHealthcare Systems Understanding

Soft Skills

CollaborationCommunicationCultural CompetencyIndependent WorkTeamwork

Tools & Technologies

Microsoft Office SuiteCase Management SoftwareElectronic Health Records

Certifications & Qualifications

Licensed Social Worker (LSW)Licensed Professional Counselor (LPC)Licensed Bachelors Social Worker (LBSW)Licensed Clinical Social Worker (LCSW)Licensed Master Social Worker (LMSW)

Industry Keywords

Healthcare NeedsModerate Complexity Health NeedsQuality ImprovementsWorkflow EfficienciesDiverse Populations

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 other healthcare providers
Coordinate care plans, referrals, specialist services, and community 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
Collaborate and communicate with physicians, providers, coworkers, and other 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

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: Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Bachelors Social Worker (LBSW), Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Licensed Graduate Social Worker (LGSW), Licensed Certified Social Worker (LCSW), 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
Proficiency in using Microsoft Office Suite, case management software, and electronic health records
Understanding of healthcare systems and case management principles
Strong assessment and care planning skills
Ability to work independently and as part of a team
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
Travel required: 0%–25%