Complex Case Manager RN - Pediatrics (Remote)

Lensa; East Montpelier (VT); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare organization is seeking a Complex Case Manager RN specializing in Pediatrics. The role involves managing a panel of members, developing care plans, and collaborating with a multidisciplinary team to improve health outcomes. Candidates should possess strong communication skills, an RN license, and extensive experience in clinical or case management settings.

Qualifications

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

Responsibilities

• Oversee a panel of members and assess needs.
• Create and implement care plans with follow-up schedules.
• Achieve targeted patient outcomes and ensure documentation compliance.

Skills

Strong communication

Negotiation

Analytical skills

Understanding of disease processes

Healthcare systems

Proficiency in MS Excel

Data interpretation

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:

Summary: This role involves managing a panel of members with varying health statuses and needs. The incumbent assesses health management needs, identifies appropriate interventions, and collaborates with a multidisciplinary team to support members in achieving health goals. Responsibilities include developing care plans, conducting outreach, addressing barriers, and monitoring outcomes to improve clinical, financial, and functional metrics.

Essential Responsibilities:

• Oversee a panel of members, assess needs, and triage to resources.
• Create and implement care plans with goals and follow-up schedules.
• Achieve targeted patient outcomes and ensure documentation compliance.
• Stay updated on CMS, state, and regulatory standards.

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.

Licenses and Certifications:

• Required: RN license in PA, WV, DE, or NY (others within 6 months).
• Preferred: Case Management Certification.

Skills:

• Strong communication, negotiation, and analytical skills.
• Understanding of disease processes and healthcare systems.
• Proficiency in MS Excel and data interpretation.

Additional Details:

Travel: 0-25%

Position: Office-Based, with occasional training and travel.

Physical Demands: Lifting up to 25 pounds rarely required.

Salary Range: $57,700 - $107,800.

Compliance: Adheres to HIPAA, company policies, and ethical standards.