Complex Case Manager RN - Pediatrics (Remote)

Lensa; East Montpelier (VT); 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 assessing health management needs and collaborating with a multidisciplinary team to develop care plans. Candidates should have significant clinical experience, a valid RN license, and strong communication skills.

Qualifications

• 7 years of clinical, case management, or related experience required.
• RN license in PA, WV, DE, or NY (others within 6 months).
• Preferred: Case Management certification.

Responsibilities

• Maintain oversight of members and assess health needs.
• Create and manage care plans with goals.
• Achieve targeted patient outcomes and document activities.

Skills

Communication

Negotiation

Analytical

Organizational

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Job description

Complex Case Manager RN - Pediatrics (Remote)

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Company : Highmark Inc.

Job Description :

JOB SUMMARY

This role involves primary ownership over a panel of members with diverse health statuses and clinical needs. The incumbent assesses health management needs, utilizes data/analytics along with clinical judgment to determine appropriate interventions, and collaborates with a multidisciplinary team to refer members to suitable resources. Responsibilities include developing care plans, encouraging behavioral changes, addressing barriers, coordinating care, and monitoring quality outcomes for the panel.

ESSENTIAL RESPONSIBILITIES

• Maintain oversight of members, assess health needs, and triage to resources.
• Create and manage care plans with goals and regular re-assessment contacts.
• Achieve targeted patient outcomes and document activities in compliance with standards.
• Stay informed of regulatory requirements and adhere to standards of practice.
• 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, advanced 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 within 6 months).

Preferred:

• Case Management certification.

SKILLS

• Strong communication, negotiation, analytical, and organizational skills; ability to work independently in a high-performance environment.

OTHER INFORMATION

Position is office-based with travel up to 25%. Physical demands include occasional lifting up to 50 pounds. The role requires compliance with HIPAA, privacy policies, and ethical standards. Salary range: $57,700 - $107,800.