Specialist Case Manager, RN

Highmark Health

Remote RN case manager coordinating complex care plans for Highmark health plan members. Assessing needs, improving outcomes, and controlling healthcare costs.

Posted 9/10/2026full-timeAlabama, Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming • 🇺🇸 United StatesSeniorLead💰 $86,400 - $138,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in case management services, including developing individualized care plans, monitoring member progress, and advocating for healthcare needs. Proficient in navigating complex healthcare systems and ensuring compliance with regulatory requirements.

Highest-signal resume keywords

Case Management ServicesCurrent State RN LicensureCertified Case Manager (CCM)Healthcare System NavigationData Interpretation and Recommendations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCare Plan DevelopmentIntervention EvaluationAnalytical SkillsProblem-Solving Skills

Soft Skills

Excellent Communication SkillsCollaboration SkillsPresentation Skills

Tools & Technologies

Microsoft SuiteCase Management SoftwareElectronic Health RecordsGenerative AI

Certifications & Qualifications

Certified Case Manager (CCM)

Industry Keywords

HIPAA ComplianceHealthcare RegulationsAccreditation RequirementsDisease Condition ManagementProvider Operations

About the role

Key responsibilities & impact

Provide case management services to members with highly complex or specialized needs
Maintain oversight of an assigned member panel through ongoing assessment, clinical intervention identification, and triage
Develop and implement strategies to improve outcomes and reduce costs for specialized populations
Assess members’ health status, needs, and available resources
Develop individualized care plans with members, physicians, and healthcare providers
Implement and coordinate care plans and access to services and resources
Monitor member progress and adjust care plans as needed
Evaluate intervention and service effectiveness
Advocate and act as a liaison for members’ healthcare needs
Collaborate with physicians, providers, coworkers, and healthcare team members
Document activities in compliance with business, regulatory, and accreditation requirements
Serve as a subject matter expert and train other case managers
Perform other duties as assigned

Requirements

What you’ll need

7 years of experience in any combination of clinical, case/utilization management, disease condition management, provider operations, and/or health insurance experience
Bachelor’s degree in Nursing or relevant experience and/or education in lieu of bachelor's degree
Current State RN licensure OR current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
Certified Case Manager (CCM) certification must be obtained within 36 months of hire
In-depth knowledge of the specialized area, including best practices and emerging treatments
Expertise in navigating complex healthcare systems and resources
Strong analytical and problem-solving skills
Strong proficiency in Microsoft suite of applications, case management software, and electronic health records
Excellent communication and presentation skills
Skill in using generative AI
Ability to interpret data and make data-based recommendations
Must comply with HIPAA, company privacy and information security policies, code of business conduct, applicable laws, regulations, and training requirements

Benefits

Comp & perks

Remote work option
Travel requirement of 0%–25%
Base pay range of $86,400–$138,600 per year