[Hiring] Senior Case Manager RN - Transplant 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.
• Transplant specific clinical experience (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).
• High School/GED (required).
• Bachelors in Nursing (preferred).
• 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).
• Certification in clinical area of expertise (e.g., OCN, CPN, CPON, CNN, CCTC, CPHQ) (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

• Pay Range Minimum: $79,300.00
• Pay Range Maximum: $127,100.00
• Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.

Company Description

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.