disease case manager rn

Highmark Health

<div><h2 class="jobSectionHeader">Company :
</h2>Highmark Inc.
<h2 class="jobSectionHeader">Job Description :
</h2>JOB SUMMARY
This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. The incumbent monitors, improves and maintains quality outcomes (clinical, financial and functional) for the specified panel of members.
ESSENTIAL RESPONSIBILITIES
<ul><li>Maintain oversight over specified panel of members by performing ongoing assessment of members&rsquo; health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support.
</li><li>For assigned case load, create care plans to address members&rsquo; identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment.
</li><li>Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved.
</li><li>Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.
</li><li>Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.
</li><li>Other duties as assigned or requested.
</li></ul>EDUCATION
Required
<ul><li>High School Diploma/GED
</li></ul>Substitutions
<ul><li>None
</li></ul>Preferred
<ul><li>Bachelor's Degree in Nursing
</li></ul>EXPERIENCE
Required
<ul><li>7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience
</li></ul>Preferred
<ul><li>Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)
</li><li>Experience working with the healthcare needs of diverse populations
</li><li>Understanding of the importance of cultural competency in addressing targeted populations
</li></ul>LICENSES AND CERTIFICATIONS
Required
<ul><li>Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment.
</li></ul>Preferred
<ul><li>Certification in Case Management
</li></ul>SKILLS
<ul><li>Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
</li><li>Broad knowledge of disease processes
</li><li>Understanding of healthcare costs and the broader healthcare service delivery system
</li><li>Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data
</li><li>Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
</li><li>Ability to work in a high performing team environment that requires flexibility
</li><li>Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills
</li><li>Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy
</li></ul>LANGUAGE REQUIREMENT (Other than English)
 
None
TRAVEL REQUIREMENT
0% - 25%
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
Position Type
Office-Based
Teaches/Trains others regularly
Rarely
Travels regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (Sales employees)
Does Not Apply
Physical Work Site Required
No
Lifting: up to 10 pounds
Rarely
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
 
 
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 
 
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company&rsquo;s Handbook of Privacy Policies and Practices and Information Security Policy.
 
 
Furthermore, it is every employee&rsquo;s responsibility to comply with the company&rsquo;s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$72,700.00
Pay Range Maximum:
$116,600.00
Base pay is determined by a variety of factors including a candidate&rsquo;s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
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.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice</div>

Complex Case Manager RN - Oncology (Remote)

CentraCare

<div>Join the inpatient Care Management team at St. Cloud Hospital as Registered Nurse Case Manager.
As an integral part of the St. Cloud Hospital Case Management System, the Registered Nurse Case Manager works with the interdisciplinary team in facilitating patient care by following the American Case Management Association's Standards of Practice: collaboration, communication, facilitation, coordination, advocacy, and resource management. This Case Manager position will support our Surgical Care and Observation Unit at St. Cloud Hospital. You will be accountable for a designated patient caseload and plan care effectively to meet patient/family transitional needs, monitor length of stay, and promote efficient utilization of resources. Facilitates the collaborative management of patient care across the health care continuum, intervening as necessary to remove barriers to timely and efficient care delivery, and reimbursement.
<ul><li>Schedule
<ul><li>Full-time | 80 hours every two weeks | Onsite
</li><li>Day shift | Monday - Friday | 7:30am-4pm
</li><li>Occasional weekend &amp; holiday rotation
</li></ul></li><li>Pay and Benefits
<ul><li>Pay rate minimum: $42.37 (BSN); $43.43 (MSN), pay determined by experience
</li><li>Earn extra pay for working weekend shifts
</li><li>$3,500 hiring bonus and $5,000 relocation bonus for eligible candidates!
</li><li>Full time benefits : medical, dental, PTO, retirement, employee discounts and more!
</li><li>Tuition reimbursement and college grant programs available
</li></ul></li><li>Qualifications
<ul><li>Graduate from a nursing program
</li><li>BSN or higher degree in nursing required.
</li><li>2 years or more of clinical experience as an RN required.
</li><li>Registered Nurse in MN required.
</li><li>Current American Case Management Association (ACMA Certification - RN) or obtained within 5 years required.
</li></ul></li></ul>Hiring bonus requirements: To be eligible for the hiring bonus you must be an external candidate who is hired into an eligible full-time or part time benefited position. Previous CentraCare/Carris employees qualify if they have not worked for CentraCare for at least 9 months at the date of hire.
Relocation assistance requirements: Must accept a position that offers benefits and may not have worked for CentraCare in the last 9 months. Must currently reside more than 50 miles away from St. Cloud Hospital and relocate to within 30 miles of it.
**CentraCare pay promotions to include but not limited to, Accelerated Rates and Bonuses may be discontinued at any time due to business needs**
CentraCare Health has made a commitment to diversity in its workforce and all individuals, including, but not limited to, individuals with disabilities, are encouraged to apply. CentraCare Health is an EEO/AA employer.</div>

Case Manager Registered Nurse

United Energy Workers Healthcare

<div>
 We are a compassionate company driven by a personal commitment to exceptional care. Founded by the grandchildren of a former Department of Energy worker,
 
 we elevate the lives of energy workers with unwavering compassion and whole-person care.
 
 
 
 Our mission is guided by our founders' deep commitment to high-quality care under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). With over 14 years of experience and operations across 24 states, we strive to make a meaningful difference in the lives of energy workers and their families.
 
 
 We are seeking a skilled
 
 Registered Nurse Case Manager
 
 to join our team. This role is crucial in assessing patient needs, coordinating care, and ensuring effective communication among all parties involved in patient care.
 
 
 <ul>
 <li>
 Manage Nursing Care Oversee the coordination of nursing care, home health aide services, and applicable therapies once approved by the Department of Labor.
 </li>
 <li>
 Ensure Confidentiality Maintain confidentiality of all client and office records in accordance with HIPAA guidelines and the Privacy Act PHI.
 </li>
 <li>
 Facilitate Communication Ensure effective communication and collaboration among the care team to provide cohesive and comprehensive care.
 </li>
 <li>
 Additional Duties Perform other duties as assigned to support the team and enhance patient care.
 </li>
 <li>
 Current RN License Valid and active Registered Nurse license in good standing.
 </li>
 <li>
 Experience At least one year of experience in a home health setting, or related area, with strong assessment skills.
 </li>
 <li>
 Organizational Skills Excellent organizational and time management skills to handle multiple clients efficiently.
 </li>
 <li>
 Tech Savvy Proficient in computer and internet-based applications, as well as office equipment.
 </li>
 <li>
 Equipment Knowledge Competent working knowledge of client-based equipment.
 </li>
 <li>
 Background Check Must pass a criminal background check and sanction screening.
 </li>
 <li>
 Professional Appearance Professional demeanor and appearance are necessary.
 
 
 
 </li>
 </ul>
 USD $38.00 - USD $42.00 /Hr.
</div>

Case Manager ( RN )

The Cigna Group

<div>Position Scope
Hours for the position: Must be able to work an 8-hour-shift between the business hours of 9a-9p EST. Flexibility is required to meet business needs. Must be open to work evenings.
Role Summary: 
The Nurse Case Manager serves as a customer advocate, partnering with members, families, and providers to coordinate care and support navigation of the healthcare system. This role focuses on whole-person health, behavior change, and delivering high-quality, customer-centered outcomes aligned with Care Solutions cultural beliefs.
Key Responsibilities:<ul><li>
Partner with customers to develop, implement, and document individualized care plans.</li><li>
Use motivational interviewing, behavior change strategies, and shared decision-making to support health goals.</li><li>
Coordinate care with providers, caregivers, and internal clinical partners to support whole-person health.</li><li>
Engage customers through telephonic, digital, and written communication channels.</li><li>
Track and document activities, outcomes, and progress in medical management systems.</li><li>
Follow standard operating procedures and meet defined case management performance measures.</li><li>
Maintain clinical expertise through required training and continuing education.</li></ul>
Required Qualifications:<ul><li>
Active, unrestricted Registered Nurse (RN) license in a U.S. state or territory.</li><li>
Minimum of two (2) years of full-time direct patient care experience as an RN.</li><li>
Nursing degree from an accredited nursing program.</li><li>
Ability to work an 8-hour shift between 9:00 a.m. and 9:00 p.m. EST, including evenings as business needs require.</li><li>
Strong communication skills across telephonic and digital platforms.</li><li>
Proficiency with Microsoft Word, Excel, Outlook, and clinical documentation systems.</li></ul>
Preferred Qualifications:<ul><li>
Case management certification (URAC-recognized) obtained within four (4) years of hire.</li><li>
Experience working in remote, telephonic, or digital care management environments.</li><li>
Strong organizational skills with the ability to manage multiple priorities in a fast-paced setting.</li><li>
Demonstrated ability to work effectively with culturally diverse populations.</li><li>
Flexibility to support non-standard shifts or occasional on-site meetings or audits</li></ul> 

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 77,500 - 129,100 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you&rsquo;ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you&rsquo;ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.</div>

(RN) Nurse Case Manager - Evernorth Health Services -Remote

Position Scope
 
Hours for the position: Must be able to work an 8-hour-shift between the business hours of 9a-9p EST. Flexibility is required to meet business needs. Must be open to work evenings.
 
Role Summary: 
The Nurse Case Manager serves as a customer advocate, partnering with members, families, and providers to coordinate care and support navigation of the healthcare system. This role focuses on whole-person health, behavior change, and delivering high-quality, customer-centered outcomes aligned with Care Solutions cultural beliefs.
 
Key Responsibilities: 
<ul>
<li>Partner with customers to develop, implement, and document individualized care plans.</li>
<li>Use motivational interviewing, behavior change strategies, and shared decision-making to support health goals.</li>
<li>Coordinate care with providers, caregivers, and internal clinical partners to support whole-person health.</li>
<li>Engage customers through telephonic, digital, and written communication channels.</li>
<li>Track and document activities, outcomes, and progress in medical management systems.</li>
<li>Follow standard operating procedures and meet defined case management performance measures.</li>
<li>Maintain clinical expertise through required training and continuing education.</li>
</ul>
Required Qualifications: 
<ul>
<li>Active, unrestricted Registered Nurse (RN) license in a U.S. state or territory.</li>
<li>Minimum of two (2) years of full-time direct patient care experience as an RN.</li>
<li>Nursing degree from an accredited nursing program.</li>
<li>Ability to work an 8-hour shift between 9:00 a.m. and 9:00 p.m. EST, including evenings as business needs require.</li>
<li>Strong communication skills across telephonic and digital platforms.</li>
<li>Proficiency with Microsoft Word, Excel, Outlook, and clinical documentation systems.</li>
</ul>
Preferred Qualifications: 
<ul>
<li>Case management certification (URAC-recognized) obtained within four (4) years of hire.</li>
<li>Experience working in remote, telephonic, or digital care management environments.</li>
<li>Strong organizational skills with the ability to manage multiple priorities in a fast-paced setting.</li>
<li>Demonstrated ability to work effectively with culturally diverse populations.</li>
<li>Flexibility to support non-standard shifts or occasional on-site meetings or audits</li>
</ul>
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
 
For this position, we anticipate offering an annual salary of 77,500 - 129,100 USD / yearly, depending on relevant factors, including experience and geographic location.
 
This role is also anticipated to be eligible to participate in an annual bonus plan.
 
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs,click here.
 
About Cigna Healthcare
 
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
 
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
 
If you need a reasonable accommodation to complete the online application process, please emailseeyourselfthecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
 
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
 
Qualified applicants with criminal histories will be considered for employment in a mannerconsistent with all federal, state and local ordinances.

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary<ul><li>
Location: This role will be work at home with 25-50% travel within Southeast Michigan (Wayne and Macomb Counties).</li><li>
Schedule: Standard business hours Monday-Friday 8:00am-5:00pm EST, no night, weekends, or holiday shifts! **There is potential of moving to a four day / ten hour shift schedule after a 6 month probationary period.**</li></ul>
Our Mission
Our Field Case Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. 
Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members&rsquo; health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in new markets across the country.
Help us elevate our patient care to a whole new level!<h2 class="jobSectionHeader">
Key Responsibilities</h2><ul><li>
Visiting members in their homes to evaluate for appropriateness for waiver services, writing the waiver and submitting for approval.</li><li>
Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member&rsquo;s overall wellness.</li><li>
Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.</li><li>
 Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.</li><li>
Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.</li><li>
Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.</li><li>
Collaborates with supervisor and other key stakeholders in the member&rsquo;s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences</li><li>
Utilizes case management processes in compliance with regulatory and company policies and procedures.</li><li>
Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.</li></ul><h2 class="jobSectionHeader">
Remote Work Expectations</h2><ul><li>
This is a remote role with 25-50% travel required, candidates must have a dedicated workspace free of interruptions.</li><li>
Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.</li></ul><h2 class="jobSectionHeader">
Required Qualifications</h2><ul><li>
Registered Nurse with active MI state license in good standing</li><li>
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually</li><li>
Ability to travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise</li><li>
Excellent analytical and problem-solving skills</li><li>
Effective communications, organizational, and interpersonal skills.</li><li>
Ability to work independently</li><li>
Effective computer skills including navigating multiple systems and keyboarding</li><li>
Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint</li></ul><h2 class="jobSectionHeader">
Preferred Qualifications</h2><ul><li>
Care Management, discharge planning and/or home health care coordination experience preferred</li><li>
Certified Case Manager preferred</li></ul><h2 class="jobSectionHeader">
Educational</h2><ul><li>
Associate's Degree required.</li><li>
Bachelor's degree preferred.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$60,522.00 - $129,615.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Case Manager Registered Nurse - Field MI (Wayne and Macomb County)

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Case Manager Registered Nurse - Field MI (Wayne and Macomb County)