Complex Case Manager RN - Pediatrics (Remote)

Lensa; Boise (ID); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare organization is seeking a Complex Case Manager RN specializing in pediatrics. This remote role involves managing patient care, developing care plans, and collaborating with a multidisciplinary team. Candidates should have significant clinical experience and an RN license, with a focus on achieving optimal health outcomes.

Qualifications

• 7 years in clinical, case management, or related fields required.
• Pediatric experience and advanced behavioral therapy training preferred.
• RN license in PA, WV, DE, or NY required.

Responsibilities

• Oversee members' health management needs and identify clinical interventions.
• Create and implement care plans with goals and re-assessment schedules.
• Achieve targeted patient outcomes and document activities.

Skills

Communication

Negotiation

Interpersonal skills

Data analysis

Organizational skills

Multitasking

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 needs. The nurse assesses health management needs, utilizes data and clinical judgment to identify interventions, and collaborates with a multidisciplinary team to support members. Responsibilities include developing care plans, conducting outreach, addressing barriers, coordinating care, and monitoring outcomes to improve health, financial, and functional results.

Essential Responsibilities:

• Oversee members' health management needs, identify clinical interventions, and triage to resources.
• Create and implement care plans with goals and re-assessment schedules.
• Achieve targeted patient outcomes and document activities in compliance with standards.
• Maintain current knowledge of regulatory and practice standards.
• 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: Pediatric experience, advanced behavioral therapy training, cultural competency.

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.
• Broad disease process knowledge and understanding of healthcare systems.
• Proficiency in MS Excel and data analysis.
• Organizational and multitasking abilities.

Additional Details:

Position is office-based with travel up to 25%. No physical lifting required. The role involves compliance with HIPAA, privacy, and ethical standards. Salary range: $57,700 - $107,800, based on experience and location.