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 for Pediatrics. This remote role involves managing patient care, developing care plans, and coordinating resources to improve health outcomes. Candidates should possess strong communication skills and a background in clinical case management. The position requires an RN license and offers opportunities for professional growth within a supportive environment.

Qualifications

• 7 years in clinical, case management, or health insurance.
• Pediatric experience and training in CBT or motivational interviewing preferred.

Responsibilities

• Manage a panel of members with varying health statuses.
• Develop care plans and monitor outcomes.
• Coordinate care and address barriers.

Skills

Communication

Negotiation

Interpersonal Skills

Data Analysis

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 managing a panel of members with varying health statuses and clinical needs. The incumbent assesses health management needs, uses data and clinical judgment to identify interventions, and refers members to appropriate resources. They will develop care plans, encourage behavioral changes, address barriers, coordinate care, and monitor outcomes to improve health, financial, and functional results.

ESSENTIAL RESPONSIBILITIES

• Oversee members by assessing needs, identifying interventions, and triaging to resources.
• Create and implement care plans with goals and regular re-assessment contacts.
• Achieve targeted patient outcomes and document all activities per standards.
• Maintain knowledge of regulatory and accreditation standards, including CMS, CMSA, and ACMA guidelines.
• 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, disease management, provider operations, or health insurance.

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

LICENSES AND CERTIFICATIONS

• Required: RN license in PA, WV, DE, or NY. Other licenses must be obtained 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.
• Ability to handle multiple priorities, work autonomously, and in teams.

OTHER REQUIREMENTS

• Travel: 0-25%
• Position: Office-based, with occasional travel.

Physical and Mental Demands

Light lifting, occasional physical activity.

Note: The job description summarizes core duties and may not include all responsibilities. Compliance with legal, ethical, and privacy standards is required.