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 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 clinical, case management, and/or disease management experience required.
• RN license in PA, WV, DE, or NY required.

Nice-to-haves

• Pediatric Complex Case Management Experience
• Advanced training in cognitive behavioral therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT)
• Experience working with diverse populations and understanding cultural competency.

Benefits

• Health insurance
• Dental insurance
• 401k
• Paid holidays
• Flexible scheduling
• Professional development opportunities