Complex Case Manager RN Pediatric - (Remote)

Highmark Health

Full-time - Mid Level

Remote

Insurance Carriers and Related Activities

About the position

The Pediatric Complex Case Manager RN is responsible for overseeing a panel of pediatric members with varying health statuses and clinical needs. This role involves assessing health management needs, utilizing data and analytics to determine appropriate clinical interventions, and managing an active caseload. The incumbent will develop care plans, encourage behavior changes, and coordinate care to help members achieve their health goals, while ensuring compliance with regulatory standards and maintaining quality outcomes.

Responsibilities

• Maintain oversight over specified panel of members by performing ongoing assessment of members' health management needs.
• Create care plans to address members' identified needs, remove barriers to care, and identify resources.
• Ensure targeted percentage of patient goal achievement and other patient outcomes are achieved.
• Document all activities in compliance with business process requirements and regulatory standards.
• Maintain current knowledge of applicable CMS, state, local, and regulatory agency requirements.

Requirements

• High School Diploma/GED required; Bachelor's Degree in Nursing preferred.
• 7 years of a combination of clinical, case management, and/or disease/condition management experience required.
• RN license in PA, WV, DE, or NY required; other licenses must be obtained within the first 6 months of employment.
• Pediatric Complex Case Management experience preferred.
• Advanced training in cognitive behavioral therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT) preferred.

Nice-to-haves

• Experience working with the healthcare needs of diverse populations.
• Understanding of cultural competency in addressing targeted populations.
• Certification in Case Management preferred.

Benefits

• Health insurance coverage
• Dental insurance coverage
• 401k retirement savings plan
• Paid holidays
• Flexible scheduling options
• Professional development opportunities