Medical Case Manager - Delaware

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Medical Case Manager - Delaware

Work At Home - Delaware, Home DE 90001, United States

Full time

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Job DescriptionWorking with UsBenefits & PerksHear From Our TeamHow We Hire

Job Details

Category Clinical Services

Type Full time

Location(s) Work At Home - Delaware, Home DE 90001, United States

Brand Highmark Inc.

Posted 11/10/2026

Req ID J289836

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Job Description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This role requires some travel to facilities, member homes, and our main office in Wilmington.

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 moderate complexity health needs.
• 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.
• Develop and implement care plans with minimal guidance.
• Coordinate referrals to specialists and community 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 communicate clearly and professionally with physicians, providers, co-workers and other members of the health care team to carry out the established plan of care.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements, company policies, regulatory requirements and accreditation standards.
• Identify areas for potential cost savings, quality improvement and workflow efficiencies.
• Other duties as assigned or requested.

EXPERIENCE

Required

• 3 years of experience in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience with RN licensure or a Master's degree OR; 5 years' experience with a Bachelor's in Social Work

Preferred

• Advanced Generalist to include experience working with pregnant/postpartum individuals, adults with chronic medical conditions or behavioral health/substance use disorders, pediatrics, and individuals with intellectual/developmental disorders.
• Medicaid managed care and/or Medicare experience
• Experience working with the healthcare needs of diverse populations
• Experience demonstrating understanding of importance of culture competency in addressing targeted populations

SKILLS

• Strong assessment and care planning skills.
• Ability to work independently and as part of a team.
• Proficiency in using Microsoft office suite, case management software and electronic health records.
• Understanding of healthcare systems and case management principles
• Bilingual English/Spanish language skills preferred

EDUCATION

Required

• 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

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• Licensed Social Worker (LSW)-Non-Specific - State (OR) Licensed Professional Counselor (LPC) - Non-Specific State (OR) Licensed Bachelors Social Worker (LBSW) (OR) Licensed Clinical Social Worker (LCSW) - Non-Specific (OR) Licensed Master Social Worker (LMSW) Non-Specific (OR) Licensed Graduate Social Worker (LGSW) (OR) Licensed Certified Social Worker (LCSW) (OR) Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Incumbents in the role prior to 1/1/25 who are not currently licensed must obtain licensure by 12/31/27.

Preferred

• Certified Case Manager (CCM)

Language (Other than English):

None

Travel Required:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based or Remote Position

Physical work site required

Occasionally

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's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's responsibility to comply with the company'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'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.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Why Choose Highmark Inc.?

As one of the nation"s leading health insurers, Highmark Inc. relies on a passionate team of over 5,000 people to make healthcare higher-quality, accessible, and affordable. We are known for how deeply we care-about our members and our employees. If you are looking to build a career with real purpose, you belong at Highmark.

Benefits & Perks

Taking Care of You

Your Benefits at a Glance

• Health: Complete medical, dental, vision, prescription, HSA, and FSA coverage.
• Time Off: Paid vacation, holidays, and dedicated volunteer time.
• Finance: Employer-sponsored 401(k), life/disability insurance, and tuition reimbursement.
• Perks: Exclusive team discounts on shopping, memberships, and events.

Medical Coverage

Medical, prescription drug, dental, and vision coverage

Paid Time Off

Vacation, holidays, volunteering

Retirement Package

Employer-sponsored 401(k) plan

Insurance & Coverage

Life, AD&D and disability insurance

Onsite & Preventative Care

We make staying healthy easy with 100% covered preventative exams (including flu shots) and onsite pharmacy services at major campuses. Plus, stay active with free fitness center access at major Highmark campuses, Allegheny General, and West Penn Hospital.

Make Mindful Changes

Secure bicycle parking at major campuses. Healthy food options at onsite cafeterias. Stress management classes including yoga, mindfulness, and meditation.

Holistic Support, 24/7

Work-life resources including assistance programs and financial counseling services. 24/7 telephone access to health and wellness coaching.

Get Rewarded for Giving Back

Health incentive program that rewards team members. Team member networks to gather in the name of health. Paid volunteer time and incentives for making a difference.

Hear from Our Team

Real people, real stories

"I have met some really great people over the years at Highmark Health and the company has treated me really well. I get really good benefits. I"ve always been rewarded for working hard. That"s what keeps me here."

Victoria T.

Associate Strategy Analyst, enGen

"I love participating with the PRIDE BRG. It"s an engaged, dynamic group of almost 400 people. I also love to turn on the digital hub on my computer and see what"s going on with any of the Business Resource Groups. It"s really neat to be able to support other BRGs and see others support PRIDE. Every time I go to a different BRG event, I always feel welcome, even if I"m not part of that group."

Amanda M.

Director of Social Determinants of Health | Vice Chair of PRIDE

Our Hiring Process: Step-by-Step

1. Apply

Find a role that sparks your passion and submit your application! We'll send an immediate confirmation email, and our team will review your qualifications over the next 1-2 weeks.

2. Interview

If your profile is a great match, we'll reach out to schedule your interview-whether by phone, video, or in person. Don"t worry, we'll provide all the prep details in advance so you can shine.

3. Job Offer

The moment you've been waiting for! If selected, we'll connect to celebrate and walk you through the details: compensation, benefits, paid time off, and all the perks of joining the team.

4. Pre-Employment

After you accept online, we'll guide you through standard screening (including a background check and drug screen, plus health screenings for certain clinical roles). Once cleared, we"ll officially confirm your start date!

5. Onboarding

Welcome aboard! Before Day 1, we'll send everything you need to hit the ground running-including your schedule, location, and the required identification documents to bring with you.

Bonus Fast-Track Tip

Applying for EVS, Dietary, or Customer Service roles? You can skip the traditional line and chat with Bridget, our AI recruiting assistant, to find open roles and schedule an eligible interview instantly.

Apply Now

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Highmark Health is an independent licensee of the Blue Cross Blue Shield Association.

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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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

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