Complex Case Manager RN (Maternity-NICU)

TL;DR

Complex Case Manager RN (Maternity-NICU): Managing a panel of members with complex clinical needs by assessing health requirements and coordinating multi-disciplinary interventions with an accent on maternity and NICU care. Focus on developing personalized care plans, removing barriers to care, and improving clinical and financial outcomes through data-driven decision-making.

Location: Must be based in Pennsylvania (Remote)

Company

A leading health insurance and care delivery organization dedicated to improving health outcomes and providing high-quality service to its members.

What you will do

• Maintain oversight of a member panel by assessing health needs and identifying appropriate clinical interventions.
• Develop and manage comprehensive care plans with both long and short-term goals for members.
• Conduct member outreach to encourage behavior changes and address barriers to care.
• Coordinate care and refer members to appropriate multi-disciplinary resources.
• Monitor and improve clinical, financial, and functional quality outcomes for the assigned panel.
• Ensure all activities comply with regulatory requirements, accreditation standards, and HIPAA guidelines.

Requirements

• Current State of PA RN licensure or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
• Bachelor's Degree in Nursing.
• 7 years of experience in clinical, case management, disease management, provider operations, or health insurance.
• Broad knowledge of disease processes and the healthcare service delivery system.
• Proficiency in MS Excel and strong analytical skills to interpret clinical and financial data.
• Excellent interpersonal, negotiation, and consensus-building skills.

Nice to have

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

Culture & Benefits

• Opportunity to work in a high-performing, collaborative team environment.
• Focus on professional autonomy and self-directed work.
• Adherence to high ethical and legal standards in a regulated healthcare environment.
• Support for ongoing professional development and adherence to standards of practice.