Complex Case Manager RN - Pediatrics (Remote)

Lensa; Columbus (OH); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare company is seeking a Complex Case Manager RN specializing in Pediatrics. The role involves overseeing a panel of members, assessing their health needs, and collaborating with a multidisciplinary team to improve health outcomes. The ideal candidate will have significant clinical experience and strong communication skills. This remote position offers a competitive salary based on experience and location.

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 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

Interpersonal Skills

Data Analysis

Organizational Skills

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 :

JOB SUMMARY

This role involves ownership and oversight of a specific panel of members with diverse 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 outcomes to improve health, financial, and functional metrics.

ESSENTIAL RESPONSIBILITIES

1. Oversee a panel of members, assessing health 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 standards.
4. Maintain current knowledge of applicable regulations and 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, cultural competency.

LICENSES AND CERTIFICATIONS

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

Preferred:

• Case Management Certification.

SKILLS

• Strong communication, negotiation, and interpersonal skills.
• Knowledge of disease processes, healthcare costs, and data analysis.
• Proficiency in MS Excel, organizational, and time management skills.
• Ability to work autonomously and handle multiple priorities.

Additional Details

Travel: 0-25%

Position Type: Office-Based

Physical demands include lifting up to 25 pounds rarely.

Compliance: Adherence to HIPAA, privacy policies, and company conduct policies required.

Compensation Range

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