Senior Case Manager RN - Transplant RN

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for providing comprehensive case management services to members, ensuring quality, cost-effective care delivery, and promoting optimal health outcomes. The Case Manager assesses member needs, develops and implements care plans, coordinates services, and monitors progress, while containing the cost of health care services. The incumbent will assist in containing the cost of health care services by detecting, resolving and preventing improper utilization of member benefits. ESSENTIAL RESPONSIBILITIES Manage a caseload of members with complex health needs, requiring advanced clinical knowledge. Conduct comprehensive assessments and develop complex care plans. Assess members’ health status, needs, and available resources. Develop individualized care plans in collaboration with members, physicians, and other healthcare providers. Implement and coordinate care plans, ensuring access to appropriate services and resources. Monitor member progress toward goals and adjust care plans as needed. Evaluate the effectiveness of interventions and services. Act as an advocate and liaison to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services. This is accomplished by using communication and available resources to promote quality, cost-effective outcomes in accordance with available contract benefits. Work collaboratively and c