Complex Case Manager RN - Pediatrics (Remote)

Lensa; Washington (District of Columbia); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare organization is seeking a Complex Case Manager RN specializing in Pediatrics. This remote role involves managing a panel of members, developing care plans, and collaborating with a multidisciplinary team to ensure quality outcomes. Ideal candidates will have extensive clinical experience and strong communication skills. Join a dedicated team committed to improving patient care and outcomes.

Qualifications

• 7 years of clinical, case management, or related experience required.
• Preferred: Pediatric experience and advanced training in CBT or motivational interviewing.

Responsibilities

• Manage a panel of members with diverse health statuses.
• Create and implement care plans with regular assessments.
• Coordinate care and monitor quality outcomes.

Skills

Communication

Negotiation

Interpersonal Skills

Analytical Skills

Organizational Skills

Time Management

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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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 diverse health statuses and clinical needs. The incumbent assesses health management needs, uses data and clinical judgment to identify appropriate interventions, and collaborates with a multi-disciplinary team to refer members to necessary resources. Responsibilities include developing care plans, encouraging behavioral changes, addressing barriers, coordinating care, and monitoring quality outcomes for the assigned panel.

ESSENTIAL RESPONSIBILITIES

• Oversee a panel of members, assess health needs, and triage to resources.
• Create and implement care plans with goals and regular re-assessment contacts.
• Achieve targeted patient outcomes and document activities per standards.
• Maintain compliance with regulatory and accreditation standards.
• Stay updated on applicable laws and practice standards.
• 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, and experience with diverse populations.

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 analytical skills.
• Organizational and time management skills.
• Self-motivated with the ability to work independently.

OTHER INFORMATION

Travel: 0-25%

Position: Office-based, with occasional travel; physical demands are minimal.

Pay Range: $57,700 - $107,800

Highmark Health is committed to diversity and compliance with applicable laws. For accommodations, contact [e-mail].