Complex Case Manager RN Pediatric - (Remote)

Highmark Health - Boston, MA

Full-time - Mid Level

Remote - Boston, MA

Insurance Carriers and Related Activities

About the position

The Pediatric Complex Case Management position at Highmark Inc. involves overseeing a panel of Pediatric members with varying health statuses and clinical needs. The role requires assessing health management needs, utilizing data and analytics, and applying clinical judgment to identify appropriate interventions and referrals. The incumbent will manage an active caseload, develop care plans, and conduct outreach to members to help them achieve their health goals while ensuring compliance with regulatory standards.

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, regulatory requirements, and accreditation 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 clinical, case management, and/or disease management experience required.
• RN license in PA, WV, DE, or NY required; other licenses must be obtained within 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
• Paid time off (PTO)
• Professional development opportunities