[Hiring] Senior Case Manager RN @Highmark Health

Role Description

This job is responsible for providing comprehensive case management services to members, ensuring quality, cost-effective care delivery, and promoting optimal health outcomes. The Case Manager assesses member needs, develops and implements care plans, coordinates services, and monitors progress, while containing the cost of health care services. The incumbent will assist in containing the cost of health care services by detecting, resolving and preventing improper utilization of member benefits.

Qualifications

• 5 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.
• Specialty specific clinical experience (e.g., Oncology, Transplant, Maternity, NICU, Pediatric) - Preferred
• Experience working with the healthcare needs of diverse populations - Preferred
• Experience demonstrating understanding of importance of culture competency in addressing targeted populations - Preferred
• Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT) - Preferred

Requirements

• Expertise in clinical assessment and care planning.
• Strong leadership and mentoring skills.
• Excellent negotiation and advocacy skills.
• Proficiency in using Microsoft suite of applications, case management software and electronic health records.
• Strong understanding of healthcare systems and case management principles.

Benefits

• Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) - Required
• Certified Case Manager (CCM) certification must be obtained within 36 months of hire - Required
• Incumbents in the role as of August 2026 are exempt from this requirement.
• Certification in clinical area of expertise (e.g., OCN, CPN, CPON, CNN, CCTC, CPHQ) - Preferred

Company Description

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.