Manager, Complex Case Management

Highmark   •  

Wilmington, DE

Industry: Managed Care & Health Insurance


5 - 7 years

Posted 341 days ago


This job will lead a team of Registered Nurse Complex Case Managers that deliver case management services to a specified panel of the Organization's members that range in health status/severity and clinical needs.  Accountable for daily operation of unit including staffing and scheduling to ensure that member outreach is effective and completed within defined timeframes and according to established processes.  This job ensures that team members are clinically competent and adequately trained in order to achieve member engagement targets as well as defined clinical and financial outcomes.  Establishes and monitors individual and team performance goals providing feedback and taking action to ensure that goals are achieved.


  • Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
  • Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
  • In collaboration with the Director, assists with focusing activities toward a strategic direction as well as develop tactical plans, drive performance, and achieve targets.
  • Ensures that team members are clinically competent and adequately trained in motivational interviewing and other engagement techniques in order to achieve the market’s engagement and clinical targets for assigned population.  Ensures on-going staff development through education and opportunities for professional development.
  • Reviews department performance in relation to established metrics and implements changes in collaboration with other multidisciplinary team managers to effect continual improvement in the services provided.
  • Leads/participates in both departmental and interdepartmental workgroups to continually enhance the delivery of programs and services and proactively respond to changing client and market expectations.
  • In collaboration with the Director, participates in preparation of department budget.  Makes budgetary recommendations and projections.  Monitor, verify, and reconcile expenditures of budgeted funds.  Identify cost savings opportunities within the department and/or operations.
  • Ensures that all services are delivered consistent with applicable internal policies and procedures as well as applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management.
  • Other duties as assigned or requested.



  • Bachelor's Degree- Nursing
  • Registered Nurse
  • 7 years' of any combination of clinical and case management experience
  • 3 years' management/supervisory experience or experience leading/working on project teams


  • Nursing
  • Certification in Case Management

  • Experience working with the healthcare needs of diverse populations
  • Understanding of the importance of cultural competency in addressing targeted populations


  • Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
  • Excellent interpersonal and communication skills and the ability to work in a matrix management environment
  • Understanding of healthcare costs and the broader healthcare service delivery system
  • Strong analytic skills with ability to interpret, evaluate and act on productivity, clinical and financial data
  • Proficient computer skills, including Microsoft Office products. Proficiency in MS Excel and enhanced data and statistical analysis skills
  • Excellent interpersonal/consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
  • Ability to work in a high performing team environment that requires flexibility
  • Excellent organizational, time management and project management skills  Demonstrated ability to handle multiple priorities in a fast paced environment