Complex Case Manager RN - Pediatrics (Remote)

Highmark; Pennsylvania; Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare company is seeking a Complex Case Manager RN specializing in pediatrics to manage a panel of members with diverse health needs. The role involves assessing health management needs, developing care plans, and collaborating with a multidisciplinary team to enhance patient outcomes. Candidates should have a strong clinical background, excellent communication skills, and a commitment to quality care.

Qualifications

• Minimum 7 years in clinical, case management, or related fields.
• Pediatric experience and advanced behavioral therapy training preferred.

Responsibilities

• Oversee a panel of members and identify clinical interventions.
• Create and manage care plans to improve health outcomes.
• Achieve targeted patient goals and document activities.

Skills

Communication

Negotiation

Interpersonal Skills

Organizational Skills

Multitasking

Education

High School Diploma/GED

Bachelor's in Nursing

Tools

MS Excel

Job description

Complex Case Manager RN - Pediatrics (Remote)

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Job Summary

This role involves managing a panel of members with varying health statuses and needs. The incumbent assesses health management needs, uses data and clinical judgment to identify interventions, and collaborates with a multidisciplinary team to refer members to appropriate resources. Responsibilities include developing care plans, encouraging behavior change, addressing barriers, coordinating care, and monitoring quality outcomes.

Essential Responsibilities

• Oversee a panel of members, assess needs, and identify clinical interventions or referrals.
• Create and manage care plans to improve health outcomes and remove barriers.
• Achieve targeted patient goals and document activities in compliance with standards.
• Stay current with regulatory and practice standards for case management.

Qualifications

Education: High School Diploma/GED required; Bachelor's in Nursing preferred.

Experience: Minimum 7 years in clinical, case management, or related fields; pediatric experience and advanced behavioral therapy training preferred.

Licenses & Certifications: RN license in PA, WV, DE, or NY required; Case Management certification preferred.

Skills

• Excellent communication, negotiation, and interpersonal skills.
• Broad disease process knowledge and understanding of healthcare costs.
• Proficiency in MS Excel and data analysis.
• Strong organizational and multitasking abilities.

Additional Details

Travel: 0-25%

Position: Office-based with occasional travel; physical demands are minimal.

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

Highmark is committed to diversity and compliance with applicable laws and policies.