Complex Case Manager RN - Maternity, NICU (Remote)

Lensa; Washington (District of Columbia); 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, focusing on health management and care coordination. This remote role involves assessing health needs, developing personalized care plans, and collaborating with a multidisciplinary team to achieve optimal health outcomes. Candidates with strong communication, analytical, and organizational skills will thrive in this position. Join a forward-thinking organization dedicated to improving patient care and outcomes, where your expertise makes a meaningful difference.

Qualifications

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

Responsibilities

• Manage a panel of members and assess their health needs.
• Create and manage care plans to improve health outcomes.
• Document all activities in compliance with standards.

Skills

Communication Skills

Negotiation Skills

Analytical Skills

Organizational Skills

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Job description

Complex Case Manager RN - Maternity, NICU (Remote)

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Highmark Health, is seeking professionals. Apply via Lensa today!

Company : Highmark Inc.

Job Description :

Job Summary

This role involves managing a specific panel of members with varying health statuses and 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.

Essential Responsibilities

• Oversee a panel of members, assessing their health needs and triaging to resources.
• Create and manage care plans to improve health outcomes, setting goals and schedules for re-assessment.
• Achieve targeted patient goals and outcomes.
• Document all activities in compliance with standards and regulations.
• Stay current with CMS, state, and local regulatory requirements and standards of practice.
• Perform other duties as assigned.

Education

• Required: High School Diploma/GED

Preferred

• Bachelor's Degree in Nursing

Experience

• Required: 7 years of clinical, case management, or related experience.

Preferred

• Maternity and NICU experience, working with diverse populations, cultural competency.

Licenses and Certifications

• Required: RN license in PA, WV, DE, or NY (others to be obtained within 6 months).

Skills

• Strong communication, negotiation, analytical, and organizational skills.

Additional Information

Position is office-based with 0-25% travel, physical demands include lifting up to 25 pounds rarely, and compliance with privacy and ethical standards is mandatory.

Salary range: $57,700 - $107,800, based on qualifications and experience.