Complex Case Manager RN - Pediatrics (Remote)

Lensa; Charleston (WV); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization is seeking a Complex Case Manager RN specializing in pediatrics. This remote role involves managing a diverse panel of members, creating care plans, 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.

Qualifications

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

Responsibilities

• Manage a panel of members, assessing needs and triaging resources.
• Create and manage care plans with goals and regular re-assessments.
• Document activities in compliance with standards.

Skills

Communication

Negotiation

Interpersonal Skills

Organizational Skills

Time Management

Self-Motivation

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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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 panel of members with varying health statuses and needs. The incumbent assesses health management needs, utilizes 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 outcomes to improve health, financial, and functional metrics.

ESSENTIAL RESPONSIBILITIES

• Oversee a panel of members, assessing needs and triaging to resources.
• Create and manage care plans with goals and regular re-assessment contacts.
• Achieve targeted patient outcome goals.
• Document activities in compliance with standards and regulations.
• Stay informed of applicable regulations 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 in clinical, case management, or related fields.

Preferred: Pediatric experience, training in CBT, motivational interviewing, or DBT, and experience with diverse populations.

LICENSES AND CERTIFICATIONS

• Required: RN license in PA, WV, DE, or NY (others 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.
• Self-motivated with the ability to work independently.

OTHER INFORMATION

• Travel: 0-25%
• Position: Office-based, teaching/training, occasional travel, lifting up to 25 pounds.

Note: This description outlines core duties but may not include all responsibilities.