Complex Case Manager RN - Pediatrics (Remote)

Lensa; Boston (MA); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare provider is seeking a Complex Case Manager RN specializing in pediatrics. This role involves overseeing a panel of members, developing care plans, and collaborating with a multidisciplinary team to ensure quality outcomes. Candidates should possess strong communication skills and a valid RN license, with a preference for those with pediatric experience.

Qualifications

• 7 years in clinical, case management, or related fields required.
• Pediatric experience and advanced behavioral therapy training preferred.

Responsibilities

• Oversee a panel of members, assessing health 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

Analytical

Organizational

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 :

JOB SUMMARY

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

ESSENTIAL RESPONSIBILITIES

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

Licenses and Certifications

• Required: RN license in PA, WV, DE, or NY; others within 6 months.

Skills

• Strong communication, negotiation, analytical, and organizational skills. Proficiency in MS Excel and data interpretation. Ability to work independently and in teams.

Additional Information

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

Compensation

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

Other Details

Employment type: Full-time, Mid-Senior level, in the healthcare provider industry.