Senior Case Manager, RN

Highmark Health

Senior RN Case Manager coordinating complex member care, assessments, and cost-effective treatment plans for Highmark health insurance members. Mentoring case managers and ensuring compliant, quality outcomes.

Posted 9/10/2026full-timePennsylvania • 🇺🇸 United StatesSenior💰 $79,300 - $127,100 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment, care planning, and case management principles while effectively collaborating with healthcare teams to advocate for members' healthcare needs. Proficient in compliance with regulatory requirements and skilled in mentoring and leadership within a clinical setting.

Highest-signal resume keywords

Clinical AssessmentCare PlanningCertified Case Manager (CCM)Leadership and MentoringHealthcare Systems Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCare PlanningCase Management PrinciplesUtilization ManagementDisease Condition Management

Soft Skills

Negotiation SkillsAdvocacy SkillsCollaboration Skills

Tools & Technologies

Microsoft SuiteCase Management SoftwareElectronic Health Records

Certifications & Qualifications

Current State RN LicensureCertified Case Manager (CCM)

Industry Keywords

HealthcareRegulatory ComplianceAccreditation StandardsHIPAAInformation Security

About the role

Key responsibilities & impact

Manage a caseload of members with complex health needs
Conduct comprehensive assessments and develop complex care plans
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 appropriate services and resources
Monitor member progress 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
Promote quality, cost-effective outcomes in accordance with contract benefits
Detect, resolve, and prevent improper utilization of member benefits
Collaborate and communicate with physicians, providers, co-workers, and healthcare team members
Document activities in compliance with business, company, regulatory, and accreditation requirements
Provide guidance and mentorship to lower-level Case Managers
Serve as a resource for clinical expertise and problem-solving
Perform other duties as assigned or requested

Requirements

What you’ll need

5 years in any combination of clinical, case/utilization management, disease condition management, provider operations, and/or health insurance experience
High School/GED
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; incumbents in the role as of August 2026 are exempt
Expertise in clinical assessment and care planning
Strong leadership and mentoring skills
Excellent negotiation and advocacy skills
Proficiency in Microsoft suite of applications, case management software, and electronic health records
Strong understanding of healthcare systems and case management principles
Ability to work with physicians, providers, co-workers, and other healthcare team members
Compliance with applicable business process requirements, company policies, regulatory requirements, accreditation standards, HIPAA, privacy, information security, and code of business conduct requirements

Benefits

Comp & perks

Remote work option
Travel required less than 25%