Medical Case Manager

Highmark Health

Medical Case Manager coordinating individualized care plans and referrals for Highmark health-plan members in Pennsylvania. Managing utilization, outcomes, documentation, and healthcare costs remotely with occasional onsite work.

Posted 9/2/2026full-timePennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $72,700 - $116,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates strong assessment and care planning skills while managing a caseload of members with moderate-complexity health needs. Proficient in coordinating care plans, collaborating with healthcare teams, and ensuring compliance with regulatory requirements.

Highest-signal resume keywords

RN LicensureCase Management SoftwareAssessment SkillsCare PlanningBilingual English/Spanish

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care CoordinationHealth Needs AssessmentIndividualized Care PlansMonitoring Member ProgressEvaluating InterventionsCost Savings IdentificationCultural CompetencyTelephonic ExperienceMedicaid Managed CareMedicare Experience

Soft Skills

Team CollaborationIndependent WorkAdvocacy

Tools & Technologies

Microsoft Office SuiteElectronic Health Records

Certifications & Qualifications

Certified Case Manager (CCM)LSWLPCLBSWLCSWLMSWLGSW

Industry Keywords

Healthcare SystemsCase Management PrinciplesRegulatory ComplianceAccreditation StandardsDiverse Populations

About the role

Key responsibilities & impact

Manage a caseload of members with moderate-complexity health needs
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
Coordinate referrals to specialists and community 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
Collaborate and communicate with physicians, providers, co-workers, and healthcare team members
Document activities in compliance with business processes, company policies, regulatory requirements, and accreditation standards
Identify potential cost savings, quality improvements, and workflow efficiencies
Perform other duties as assigned or requested

Requirements

What you’ll need

3 years of experience in any combination of clinical, case/utilization management, disease condition management, provider operations, and/or health insurance experience with RN licensure or a Master’s degree
5 years’ experience with a Bachelor’s in Social Work
Bachelor’s degree in nursing or RN licensure or Master’s degree in Social Work, Counseling, or related field, OR Bachelor’s degree in Social Work
Required professional license/certification: LSW, LPC, LBSW, LCSW, LMSW, LGSW, LCSW, or current State RN licensure, or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
Strong assessment and care planning skills
Ability to work independently and as part of a team
Proficiency in Microsoft Office Suite, case management software, and electronic health records
Understanding of healthcare systems and case management principles
Bilingual English/Spanish language skills preferred
Telephonic experience preferred
Medicaid managed care and/or Medicare experience preferred
Experience working with the healthcare needs of diverse populations preferred
Experience demonstrating understanding of cultural competency preferred
Certified Case Manager (CCM) preferred
Must comply with HIPAA, data security guidelines, company policies, legal requirements, and accreditation standards

Benefits

Comp & perks

Remote work option
Base salary range of $72,700–$116,600 per year
Travel required: 0%–25%