Manager Complex Case Management - RN (Remote)

Highmark Health - Trenton, NJ

Full-time - Manager

Remote - Trenton, NJ

Insurance Carriers and Related Activities

About the position

The Manager of Complex Case Management at Highmark Health is responsible for leading a team of Registered Nurse Complex Case Managers who provide case management services to a diverse panel of members with varying health statuses and clinical needs. This role involves overseeing daily operations, ensuring effective member outreach, and maintaining clinical competency among team members to achieve engagement and clinical targets. The manager will also be accountable for performance goals, staff development, and compliance with regulatory standards.

Responsibilities

• Lead a team of Registered Nurse Complex Case Managers in delivering case management services.
• Manage daily operations including staffing, scheduling, and ensuring effective member outreach.
• Ensure team members are clinically competent and trained in engagement techniques.
• Establish and monitor individual and team performance goals, providing feedback and taking necessary actions.
• Plan, organize, and control the operations of the department, developing and implementing necessary policies and programs.
• Assist in strategic planning and tactical execution to drive performance and achieve targets.
• Review department performance metrics and implement improvements in collaboration with multidisciplinary teams.
• Participate in budget preparation, monitoring expenditures, and identifying cost-saving opportunities.
• Ensure compliance with internal policies, CMS, and regulatory agency requirements.

Requirements

• Bachelor's Degree in Nursing.
• 7 years of experience in clinical and case management roles.
• 3 years of management or supervisory experience.

Nice-to-haves

• Master's Degree in Nursing.
• Experience working with diverse populations in healthcare.
• Understanding of cultural competency in healthcare.

Benefits

• Health insurance coverage
• Paid time off
• Retirement savings plan
• Professional development opportunities