Medical Case Manager

Highmark Health

Medical Case Manager focusing on complex medical needs for members in PA, DE, WV. Ensuring quality healthcare access and holistic case management for patients in these states.

Posted 6/3/2026full-timeRemote • Pennsylvania, Virginia, West Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $72,700 - $116,600 per yearWebsite

About the role

Key responsibilities & impact

Providing case mgmt in PA, DE and WV.
Assures that members with complex medical and/or psychosocial needs have access to high quality, cost-effective health care.
Assists in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of outcomes and activities necessary to facilitate member access to healthcare services.
Advocates for the most appropriate care plan using sound clinical judgment; accurate planning, and collaboration with internal and/or external customers and contacts.
Follows established regulatory guidelines, policies, and procedures in relation to member interventions and documentation of activities related to the member’s care and progress across the continuum of care.

Requirements

What you’ll need

Minimum Bachelor’s degree in nursing or RN certification in lieu of bachelor's degree or Master’s degree in Social Work, Counseling, Education, or related field and 3 years' experience in Acute or Managed Care/ experience with Medicaid or Medicare populations.
OR Bachelor’s degree in Social Work with five years’ experience in Acute or Managed Care/ experience with Medicaid or Medicare populations.
Preferred Experience working with high-risk pregnant women OR experience working with chronic condition adult populations OR experience with pediatrics
3 years of experience in working in Acute Care/Managed Care/Medicaid and Medicare populations.
Bilingual English/Spanish language skills.
Case Management Certification

Benefits

Comp & perks

Health insurance
401(k) matching
Paid time off
Professional development opportunities
Flexible working arrangements

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

case managementholistic assessmentcare planningcoordinationmonitoringevaluationclinical judgmentdocumentation

Soft Skills

advocacycollaborationcommunication

Certifications

RN certificationCase Management Certification