Highmark Inc. is hiring a Complex Case Manager RN - GI Nurse to take primary ownership and oversight of a specified panel of members. This remote role involves assessing member needs, using clinical judgment and data to identify interventions, managing an active case load, creating care plans, and coordinating care to improve health outcomes.
What You'll Do
- Maintain oversight over a specified panel of members by performing ongoing assessment of health management needs, identifying appropriate clinical interventions, and triaging members to proper resources.
- For your assigned case load, create care plans to address identified needs, remove barriers to care, identify resources, and conduct activities to improve health outcomes.
- Ensure targeted percentage of patient goal achievement and other patient outcomes are met.
- Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements, and accreditation standards.
- Maintain current knowledge and adhere to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management.
What We're Looking For
- High School Diploma/GED
- 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience
- RN license in PA, WV, DE, or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment.
Nice to Have
- Bachelor's Degree in Nursing
- Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)
- Experience working with the healthcare needs of diverse populations
- Understanding of the importance of cultural competency in addressing targeted populations
- Certification in Case Management
Technical Stack
- MS Excel
Team & Environment
Will be supported by a multi-disciplinary team.
Benefits & Compensation
- Compensation: $57,700.00-$107,800.00
Work Mode
This is a remote position.
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.
