Pediatric Complex Case Manager RN Position

5 days ago

Jackson, Mississippi, United States Highmark Health Full time
Pediatric Complex Case Manager RN Job Summary

This role is responsible for overseeing a specified panel of pediatric members with varying health statuses and clinical needs. The incumbent assesses the health management needs of the assigned member panel and utilizes data/analytics, in conjunction with professional clinical judgment, to identify the right clinical intervention for each member. The incumbent is supported by a multi-disciplinary team and uses clinical judgment to refer pediatric members to appropriate multi-disciplinary resources.

Key Responsibilities

• Maintain oversight over specified panel of members by performing ongoing assessment of members' health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support.

• Create care plans to address members' identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment.

• Ensure targeted percentage of patient goal achievement (ie, realization of member care plan), and other patient outcomes, as applicable, are achieved.

• Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.

Requirements

• High School Diploma/GED

• 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and/or health insurance experience

• RN license in PA or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment.

Preferred Qualifications

• Pediatric Complex Case Management Experience

• Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)

• Experience working with the healthcare needs of diverse populations

• Understanding of the importance of cultural competency in addressing targeted populations

Additional Information

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

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