Complex Case Manager RN - Pediatrics (Remote)

Lensa; Richmond (VA); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare company seeks a Complex Case Manager RN to manage a panel of members with diverse health needs. Responsibilities include assessing needs, developing care plans, and coordinating care to improve health outcomes. Candidates should possess strong communication and analytical skills, with a required RN license and relevant experience.

Qualifications

• 7 years in clinical, case management, or related fields required.
• Pediatric experience preferred.
• Advanced behavioral therapy training and cultural competency preferred.

Responsibilities

• Oversee a panel of members, assess needs, and triage to resources.
• Create and implement care plans with goals and regular re-assessments.
• Achieve targeted patient outcomes and document activities per standards.

Skills

Communication

Analytical

Organizational

Interpersonal

MS Excel

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:

JOB 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 refers members to appropriate resources. They will develop care plans, encourage behavior change, address barriers, coordinate care, and monitor outcomes to improve health, financial, and functional metrics.

ESSENTIAL RESPONSIBILITIES

• Oversee a panel of members, assess needs, and triage to resources.
• Create and implement care plans with goals and regular re-assessments.
• Achieve targeted patient outcomes and document activities per standards.
• Stay compliant with regulatory and accreditation standards.
• 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, advanced behavioral therapy training, cultural competency.

LICENSES AND CERTIFICATIONS

• Required: RN license in PA, WV, DE, or NY; others within 6 months.

Preferred:

• Case Management Certification.

SKILLS

• Strong communication, analytical, organizational, and interpersonal skills; proficiency in MS Excel.

OTHER INFORMATION

Travel: 0-25%. Position is office-based. Physical demands are minimal. Adherence to confidentiality and compliance standards is required.

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

Highmark Health is an equal opportunity employer. For accommodations, contact HR Services at [e-mail].