Complex Case Manager RN - Maternity, NICU (Remote)

Lensa; Des Moines (IA); Remote; USD 57,000 - 108,000; Full time

Job summary

An established industry player is seeking a Complex Case Manager RN to oversee a diverse panel of members with varying health statuses. In this remote role, you will utilize data and clinical judgment to develop care plans and coordinate necessary interventions. Your expertise will help achieve targeted patient outcomes while navigating complex healthcare systems. This position offers the opportunity to work autonomously and make a significant impact on the health and well-being of individuals from diverse backgrounds. Join a team dedicated to improving health metrics and delivering quality care.

Qualifications

• 7+ years in clinical, case management, or related fields.
• Preferred: Maternity, NICU experience, and working with diverse populations.

Responsibilities

• Oversee a panel of members and assess health management needs.
• Create and manage care plans with goals and reassessment schedules.
• Document activities in compliance with standards and regulations.

Skills

Strong communication skills

Negotiation skills

Interpersonal skills

Knowledge of disease processes

Healthcare cost knowledge

Proficiency in MS Excel

Data analysis skills

Organizational skills

Time management skills

Ability to work autonomously

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

MS Excel

Job description

Complex Case Manager RN - Maternity, NICU (Remote)

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Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This role involves primary ownership and oversight of a specified panel of members with diverse health statuses and clinical needs. The incumbent assesses health management needs, utilizing data/analytics and clinical judgment to identify appropriate interventions. Supported by a multidisciplinary team, the incumbent will refer members to relevant resources, develop care plans, encourage behavior change, address barriers, coordinate care, and monitor outcomes to improve health, financial, and functional metrics.

ESSENTIAL RESPONSIBILITIES

1. Oversee a panel of members, assess health management needs, and triage to resources.
2. Create and manage care plans with goals and re-assessment schedules.
3. Achieve targeted patient goals and outcomes.
4. Document activities in compliance with standards and regulations.
5. Stay current with CMS, state, and regulatory requirements.
6. Perform other duties as assigned.

EDUCATION

• Required: High School Diploma/GED

Preferred:

• Bachelor's Degree in Nursing

EXPERIENCE

• Required: 7 years in clinical, case management, or related fields.
• Preferred: Maternity, NICU experience, and working with diverse populations.

LICENSES AND CERTIFICATIONS

• Required: RN license in PA, WV, DE, or NY (others within 6 months).
• Preferred: Case Management certification.

SKILLS

• Strong communication, negotiation, and interpersonal skills.
• Knowledge of disease processes and healthcare costs.
• Proficiency in MS Excel and data analysis.
• Organizational and time management skills.
• Ability to work autonomously and handle multiple priorities.

OTHER INFORMATION

Position is office-based with travel requirements of 0-25%. Physical demands are minimal. The role adheres to all legal and ethical standards, including HIPAA and company policies.

Compensation

Pay Range: $57,700 - $107,800. Base pay depends on experience and location.