Complex Case Manager RN - Pediatrics (Remote)

Lensa; Tallahassee (FL); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading company is seeking a Complex Case Manager RN specializing in Pediatrics to manage a panel of members with diverse health needs. This remote position requires developing care plans, coordinating care, and collaborating with a multidisciplinary team to achieve optimal patient outcomes. Candidates should possess a strong clinical background, excellent communication skills, and a valid RN license. Experience in pediatrics and case management is preferred.

Qualifications

• 7 years in clinical, case management, or related fields required.
• Pediatric experience and training in CBT, motivational interviewing, or DBT preferred.

Responsibilities

• Oversee a panel of members, assessing health management needs.
• Create and implement care plans with goals and regular assessments.
• Document activities in compliance with regulations.

Skills

Communication

Negotiation

Interpersonal Skills

Knowledge of Disease Processes

Healthcare Systems Knowledge

Data Analysis

Organizational Skills

Time Management

Cultural Competency

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 managing a panel of members with varying health statuses and needs. The incumbent assesses health management requirements, utilizes 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 quality outcomes.

Essential Responsibilities:

1. Oversee a panel of members, assessing their health management needs and referring to resources as needed.
2. Create and implement care plans with goals and regular re-assessment contacts.
3. Achieve targeted patient outcomes, including care plan realization.
4. Document activities in compliance with regulations and standards.
5. Maintain knowledge of CMS, state, local, and organizational standards for case management.
6. 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, training in CBT, motivational interviewing, or DBT, experience with diverse populations, cultural competency.

Licenses and Certifications:

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

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.
• Self-directed with moderate autonomy.

Additional Information:

Position is office-based with travel requirements of 0-25%. Physical demands are minimal. The role adheres to legal, ethical, and privacy standards, including HIPAA. Salary range: $57,700 - $107,800.