Complex Case Manager RN - Specialty Pediatrics (Remote)

Company

Highmark Inc.

Job Summary

This position has primary ownership and oversight over a specified panel of members that range in health status, severity, and clinical needs. The incumbent assesses health management needs of the assigned member panel and, using data and analytics in conjunction with professional clinical judgement, identifies the right clinical intervention for each member. Supported by a multidisciplinary team, the incumbent refers members to appropriate resources and manages an active case load of members enrolled in case management. The incumbent conducts outreach, develops care plans, encourages behavior changes, removes barriers, coordinates care, and identifies resources to help members achieve personal health goals. The incumbent monitors, improves, and maintains quality outcomes (clinical, financial, and functional) for the specified panel of members.

Essential Responsibilities

• Maintain oversight ...

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