Complex Case Manager RN - Pediatrics (Remote)

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

Job summary

A leading healthcare company is seeking a Complex Case Manager RN specializing in Pediatrics. This remote role involves managing patient care, developing care plans, and coordinating with multidisciplinary teams. Candidates should have extensive clinical experience, strong communication skills, and an RN license in relevant states.

Qualifications

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

Responsibilities

• Oversee a panel of members, assessing needs and triaging to resources.
• Create and manage care plans with goals and re-assessment schedules.
• Achieve targeted patient outcome goals.

Skills

Communication

Negotiation

Interpersonal skills

Organizational skills

Knowledge of disease processes

Data interpretation

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 incumbent assesses health management needs, uses data and clinical judgment to identify interventions, and coordinates care with a multidisciplinary team. Responsibilities include developing care plans, encouraging behavior change, addressing barriers, coordinating resources, and monitoring outcomes.

Essential Responsibilities:

1. Oversee a panel of members, assessing needs and triaging to resources.
2. Create and manage care plans with goals and re-assessment schedules.
3. Achieve targeted patient outcome goals.
4. Document activities complying with regulations and standards.
5. Stay current with CMS and other regulatory requirements.
6. 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, 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:

• Communication, negotiation, and influencing skills.
• Knowledge of disease processes and healthcare costs.
• Proficiency in MS Excel and data interpretation.
• Interpersonal and organizational skills.
• Ability to work autonomously and handle multiple priorities.

Additional Details:

Position is office-based with travel up to 25%. Physical demands are minimal. The role adheres to legal and ethical standards, including HIPAA compliance. Salary range: $57,700 - $107,800, based on qualifications and experience.