Complex Case Manager RN - Pediatrics (Remote)

Lensa; Phoenix (AZ); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider is seeking a Complex Case Manager RN specializing in pediatrics. This remote role involves overseeing a panel of members, developing care plans, and coordinating care to improve health outcomes. Candidates should have significant clinical experience, strong communication skills, and an RN license in relevant states.

Qualifications

• 7 years of clinical, case management, or related experience required.
• Pediatric experience and advanced behavioral therapy training preferred.
• RN license in PA, WV, DE, NY required; other states within 6 months.

Responsibilities

• Oversee a panel of members and assess their health management needs.
• Create and implement care plans with goals and scheduled follow-ups.
• Achieve targeted patient outcomes and document all activities.

Skills

Communication

Negotiation

Interpersonal skills

Data analysis

Organizational skills

Time management

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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Lensa is the leading career site for job seekers at every stage of their career. Our client, Highmark Health, is seeking professionals. Apply via Lensa today!

Company: Highmark Inc.

Job Description:

JOB SUMMARY

This role involves primary ownership and oversight of a specific panel of members with varying health statuses and clinical needs. The incumbent assesses health management needs, uses data/analytics and clinical judgment to identify appropriate interventions, and manages an active caseload. Responsibilities include developing care plans, encouraging behavioral changes, addressing barriers, coordinating care, and utilizing resources to meet members' health goals. The incumbent monitors and aims to improve quality outcomes across clinical, financial, and functional metrics.

ESSENTIAL RESPONSIBILITIES

• Oversee a panel of members, assess their health management needs, and triage to appropriate resources.
• Create and implement care plans with goals and scheduled follow-ups.
• Achieve targeted patient outcomes and document all activities in compliance with standards.
• Stay updated on regulatory requirements and standards of practice.
• Perform other duties as assigned.

MINIMUM REQUIREMENTS

Education:

• High School Diploma/GED required; Bachelor's Degree in Nursing preferred.

Experience:

• 7 years of clinical, case management, or related experience required; pediatric experience and advanced behavioral therapy training preferred.

Licenses & Certifications:

• RN license in PA, WV, DE, NY required; other states within 6 months. Case Management certification preferred.

Skills:

• Strong communication, negotiation, and interpersonal skills; knowledge of disease processes and healthcare systems; proficiency in MS Excel and data analysis; organizational and time management skills; ability to work independently and in teams.

Additional Information:

• Travel: 0-25%
• Position: Office-based with occasional travel; physical demands are minimal.

Note: This description provides a general overview and may not include all duties and requirements.