Complex Case Manager RN - Pediatrics (Remote)

Lensa; Nashville (TN); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization is seeking a Complex Case Manager RN specializing in Pediatrics to manage a diverse panel of members. The role involves assessing health management needs, creating care plans, and coordinating with a multidisciplinary team to improve health outcomes. Ideal candidates will have significant clinical experience and strong communication skills.

Qualifications

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

Responsibilities

• Oversee a panel of members, assessing needs and referring to appropriate resources.
• Create and implement care plans with short and long-term 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:

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 coordinates with a multidisciplinary team. Responsibilities include developing care plans, conducting outreach, addressing barriers, coordinating care, and monitoring outcomes to improve health, financial, and functional metrics.

Essential Responsibilities:

1. Oversee a panel of members, assessing needs and referring to appropriate resources.
2. Create and implement care plans with short and long-term goals.
3. Achieve targeted patient outcomes and document activities per standards.
4. Maintain compliance with regulatory and accreditation standards.
5. Stay informed on applicable laws and standards of practice.
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, cultural competency.

Licenses and Certifications:

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

Skills:

• Strong communication, negotiation, analytical, and organizational skills.

Additional Details:

Position is office-based with travel up to 25%. Physical demands include minimal lifting. The role adheres to all legal and ethical standards, including HIPAA and company policies.