Complex Case Manager RN - Pediatrics (Remote)

Lensa; Austin (TX); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare organization is seeking a Complex Case Manager RN specializing in pediatrics to manage a panel of members with diverse health needs. This remote position involves developing care plans, coordinating care, and collaborating with a multidisciplinary team to improve health outcomes. Ideal candidates will have extensive clinical experience, strong communication skills, and a commitment to patient care. Join a dedicated team focused on enhancing the health and well-being of children.

Qualifications

• 7 years of clinical, case management, or related experience required.
• Pediatric experience and training in CBT or motivational interviewing preferred.

Responsibilities

• Oversee a panel of members, assessing needs and triaging to resources.
• Create and implement care plans with goals and re-assessment schedules.
• Achieve targeted patient outcomes and document all activities.

Skills

Communication

Negotiation

Interpersonal

Data Analysis

Organizational

Time Management

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

MS Excel

Job description

Complex Case Manager RN - Pediatrics (Remote)

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Company:

Highmark Inc.

Job Description:

Summary: This role involves managing a panel of members with varying health statuses and clinical needs. The incumbent assesses health management needs, uses data analytics 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 outcomes to improve health, financial, and functional metrics.

Essential Responsibilities:

1. Oversee a panel of members, assessing needs and triaging to resources.
2. Create and implement care plans with goals and re-assessment schedules.
3. Achieve targeted patient outcomes and document all activities in compliance with regulations.
4. Stay current with CMS, state, local, and accreditation standards.
5. 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: Pediatric experience, training in CBT, motivational interviewing, or DBT, experience with diverse populations.

Licenses and Certifications:

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

• Preferred: Certification in Case Management.

Skills:

• Strong communication, negotiation, and interpersonal skills.
• Knowledge of disease processes and healthcare systems.
• Proficiency in MS Excel and data analysis.
• Organizational and time management skills.

Additional Information:

Position is office-based with travel up to 25%. Physical demands include minimal lifting. Adheres to all legal, ethical, and privacy standards, including HIPAA.

Compensation:

Range: $57,700 - $107,800, based on experience and location.