Complex Case Manager RN - Pediatrics (Remote)

Lensa; Phoenix (AZ); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare organization is looking for a Complex Case Manager RN specializing in Pediatrics to manage member health needs. The role involves developing care plans, coordinating care, and collaborating with a multidisciplinary team to improve health outcomes. Ideal candidates will have significant clinical experience and strong communication skills, with a focus on pediatric care.

Qualifications

• 7 years of clinical, case management, or related experience required.
• Pediatric experience and cultural competency preferred.

Responsibilities

• Manage a panel of members, assessing needs and referring them to resources.
• Create and implement care plans with goals and follow-up schedules.
• Achieve targeted patient outcomes and document activities.

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 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 behavioral changes, addressing barriers, coordinating care, and monitoring outcomes to improve health, financial, and functional metrics.

ESSENTIAL RESPONSIBILITIES

• Oversee a panel of members, assessing needs and referring them to resources.
• Create and implement care plans with goals and follow-up schedules.
• Achieve targeted patient outcomes and document activities in compliance with standards.
• Stay current with regulatory and practice standards for case management.
• 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, training in CBT, motivational interviewing, or DBT, experience with diverse populations, and cultural competency.

LICENSES AND CERTIFICATIONS

• Required: RN license in PA, WV, DE, or NY; others must be obtained within 6 months.
• Preferred: Certification in Case Management.

SKILLS

• Strong communication, negotiation, and interpersonal skills.
• Knowledge of disease processes, healthcare costs, and data analysis.
• Proficiency in MS Excel and analytics.
• Ability to handle multiple priorities and work independently.

OTHER DETAILS

Travel: 0-25%

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

Physical demands include lifting up to 25 pounds rarely.

Additional Information

This description outlines essential duties but may not include all responsibilities. Complies with legal, ethical, and privacy standards, including HIPAA.

Salary Range: $57,700 - $107,800, based on experience and location.