Complex Case Manager RN - Pediatrics (Remote)

Lensa; Salem (OR); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading company in healthcare is seeking a Complex Case Manager RN specializing in Pediatrics to manage a diverse panel of members. This remote role involves assessing health needs, creating care plans, and coordinating care to achieve optimal patient outcomes. Candidates should possess strong communication skills and a valid RN license, with a preference for those with pediatric experience.

Qualifications

• 7 years in clinical, case management, or related fields required.
• Pediatric experience preferred.
• RN license in PA, WV, DE, or NY required.

Responsibilities

• Manage a panel of members and assess health management needs.
• Develop care plans and encourage behavioral changes.
• Coordinate care and monitor outcomes.

Skills

Strong communication

Negotiation

Interpersonal skills

Knowledge of disease processes

Healthcare costs knowledge

Organizational skills

Time management skills

Self-motivated

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 refers members to appropriate resources. They will develop care plans, encourage behavioral changes, address barriers, coordinate care, and monitor outcomes, supported by a multidisciplinary team.

ESSENTIAL RESPONSIBILITIES

• Oversee a panel of members, assess needs, and triage to resources.
• Create and manage care plans with goals and re-assessment schedules.
• Achieve targeted patient outcomes and document activities per standards.
• Stay compliant with all 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 therapies, diverse populations understanding

Licenses and Certifications:

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

Skills:

• Strong communication, negotiation, and interpersonal skills
• Knowledge of disease processes and healthcare costs
• Proficiency in MS Excel and data analysis
• Organizational and time management skills
• Self-motivated with ability to work independently

Additional Information:

Position is office-based with minimal travel (0-25%). Physical demands include occasional lifting up to 50 pounds. Adheres to HIPAA, privacy, and company policies. Salary ranges from $57,700 to $107,800 based on experience and location.