Complex Case Manager RN - Maternity, NICU (Remote)

Highmark; Pennsylvania; Remote; USD 57,000 - 108,000; Full time

Job summary

An established industry player is seeking a Complex Case Manager RN specializing in Maternity and NICU care. This remote position involves overseeing a diverse panel of members, assessing their health needs, and developing tailored care plans to enhance health outcomes. The role requires collaboration with a multidisciplinary team to ensure members receive appropriate resources and support. Ideal candidates will have extensive clinical experience, strong communication skills, and a commitment to quality care. Join this forward-thinking company to make a meaningful impact in healthcare management.

Qualifications

• 7 years of clinical or case management experience required.
• RN license in PA, WV, DE, or NY is essential.

Responsibilities

• Manage a panel of members and assess their health needs.
• Create and manage care plans for better health outcomes.

Skills

Excellent communication skills

Negotiation skills

Interpersonal skills

Knowledge of disease processes

Healthcare costs knowledge

Proficiency in MS Excel

Data analysis

Organizational skills

Time management skills

Ability to work independently

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

MS Excel

Job description

Complex Case Manager RN - Maternity, NICU (Remote)

Join to apply for the Complex Case Manager RN - Maternity, NICU (Remote) role at Highmark.

Job Summary

This role involves managing a panel of members with varying health statuses and clinical needs. The incumbent assesses health management needs, uses data and clinical judgment to identify interventions, and collaborates with a multidisciplinary team to refer members to appropriate resources. Responsibilities include developing care plans, encouraging behavioral changes, addressing barriers, coordinating care, and monitoring quality outcomes for the panel.

Essential Responsibilities

1. Oversee a panel of members, assessing health needs and referring to resources.
2. Create and manage care plans to improve health outcomes.
3. Achieve targeted patient goals and outcomes.
4. Document activities in compliance with standards and regulations.
5. Maintain knowledge of applicable regulations and standards.
6. Perform other duties as assigned.

Minimum Education

• High School Diploma/GED (Required)

Preferred Education

• Bachelor's Degree in Nursing

Experience

• 7 years of clinical, case management, or related experience (Required)
• Maternity and NICU experience (Preferred)

Licenses & Certifications

• RN license in PA, WV, DE, or NY (Required)
• Case Management Certification (Preferred)

Skills

• Excellent 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 independently and in teams.

Additional Information

Travel up to 25%, office-based position, physical demands are minimal. Salary range: $57,700 - $107,800. Compliance with HIPAA and company policies required.