Manager Complex Case Management (Remote)

Highmark Health; Pennsylvania; Remote; USD 78,000 - 148,000; Full time

Job summary

An established industry player is seeking a Manager for Complex Case Management to lead a dedicated team of Registered Nurse Case Managers. This pivotal role involves overseeing daily operations, ensuring effective member outreach, and driving team performance to achieve clinical outcomes. With a focus on staff development and compliance with healthcare regulations, you will play a key role in enhancing service delivery. Join a dynamic environment where your leadership can make a significant impact on diverse populations and their healthcare needs.

Qualifications

• Bachelor's Degree in Nursing required; Master's preferred.
• 7 years clinical and case management experience required.

Responsibilities

• Manage staffing, coaching, and performance of the nursing team.
• Oversee departmental operations and budget management.
• Ensure team competency and monitor performance metrics.

Skills

Strong communication skills

Negotiation skills

Interpersonal skills

Knowledge of healthcare costs and systems

Analytical skills for data evaluation

Proficiency in MS Office

Organizational skills

Project management skills

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

MS Office

Job description

Thank you for your interest in employment at a Highmark Health company. Highmark Health uses an online application process. If you participate in the online application process through this Workday site, your personal information will be collected, including but not limited to data such as your resume and resume content, education, contact information, address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide. We will inform you how this data will be used and where it is processed. You will be asked for your consent to use the data in accordance with the Highmark Health Data Protection Statement and GDPR Data Protection Consent for Job Applicants.

Manager Complex Case Management (Remote)

Apply via remote type: Remote | Locations: PA, Working at Home - Pennsylvania | Time type: Full time | Posted: 2 Days Ago | Job requisition id: J263936

Company: Highmark Inc.

Job Description:

JOB SUMMARY

This role leads a team of Registered Nurse Complex Case Managers providing case management services to a designated panel of members with diverse health statuses and clinical needs. Responsibilities include managing daily operations, staffing, scheduling, ensuring effective member outreach, and team training to meet engagement and clinical outcomes. The manager establishes performance goals and monitors team progress.

ESSENTIAL RESPONSIBILITIES

• Manage staffing, coaching, performance, and staff development.
• Oversee departmental operations, policy implementation, and budget management.
• Develop strategic and tactical plans in collaboration with leadership.
• Ensure team competency in engagement techniques and ongoing staff development.
• Monitor performance metrics and implement improvements.
• Participate in interdepartmental initiatives to enhance services.
• Assist in budget preparation, monitoring, and cost-saving initiatives.
• Ensure compliance with policies, regulations, and standards.
• Perform other duties as assigned.

REQUIRED EDUCATION

• Bachelor's Degree in Nursing

Substitutions

• 6 years healthcare experience

Preferred

• Master's Degree in Nursing

EXPERIENCE

Required

• 7 years clinical and case management experience
• 3 years management or project leadership

Preferred

• Experience with diverse populations and cultural competency

SKILLS

• Strong communication, negotiation, and interpersonal skills
• Knowledge of healthcare costs and systems
• Analytical skills for data evaluation
• Proficiency in MS Office and data analysis
• Organizational and project management skills

Required Licensure

Registered Nurse

Preferred

Certification in Case Management

Other Information

Position is office-based with occasional travel (0-25%). Physical demands include lifting up to 50 pounds rarely. The role adheres to legal, ethical, and privacy standards including HIPAA and company policies. Salary range: $78,900 - $147,500, based on qualifications and experience.