Complex Case Manager RN - Pediatrics (Remote)

Lensa; Springfield (IL); 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 oversee a panel of members with diverse health needs. This remote role involves assessing health management needs, developing care plans, and coordinating care to help members achieve their health goals. The ideal candidate will have strong communication skills and a background in case management. Join a dedicated team committed to improving patient outcomes and ensuring high-quality care.

Qualifications

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

Responsibilities

• Assess health needs and identify interventions for members.
• Create and implement care plans to improve health outcomes.
• Ensure compliance with documentation standards.

Skills

Communication

Negotiation

Interpersonal

Organizational

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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Company:

Highmark Inc.

Job Description:

JOB SUMMARY

This role involves ownership and oversight of a specific panel of members with varying health statuses and clinical needs. The incumbent assesses health management needs, utilizes data and analytics alongside clinical judgment to identify appropriate interventions, and manages an active caseload. Responsibilities include conducting outreach, developing care plans, encouraging behavioral changes, addressing barriers, coordinating care, and identifying resources to help members achieve their health goals. The incumbent monitors and maintains quality outcomes for the panel.

ESSENTIAL RESPONSIBILITIES

1. Maintain oversight of members by assessing health needs, identifying interventions, and triaging to resources.
2. Create and implement care plans to address member needs, remove barriers, and improve health outcomes.
3. Achieve targeted patient goals and outcomes, ensuring documentation complies with standards.
4. Stay informed of and adhere to relevant regulatory and accreditation standards.
5. 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, advanced 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 to be obtained within 6 months).
• Preferred: Certification in Case Management.

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-directed with the ability to work autonomously.

Additional Information

Position is office-based with travel requirements of 0-25%. Physical demands are minimal, including occasional lifting up to 25 pounds. The role complies with all relevant legal, ethical, and privacy standards, including HIPAA. Salary ranges from $57,700 to $107,800, depending on qualifications and experience.