Pediatric Nurse Case Manager I

Role Overview

• Performing care management within the scope of licensure for members with complex and chronic care needs
• Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum
• Performing duties telephonically or on-site for discharge planning
• Ensuring member access to services appropriate to their health needs
• Conducting assessments to identify individual needs and specific care management plan
• Implementing care plan by facilitating authorizations/referrals as appropriate
• Coordinating internal and external resources to meet identified needs
• Monitoring and evaluating effectiveness of the care management plan
• Modifying care plans as necessary
• Interface with Medical Directors and Physician Advisors on care management treatment plans
• Assisting in problem solving with providers, claims, or service issues

Requirements

• Requires BA/BS in a health related field and minimum of 3 years of clinical experience
• Current, unrestricted RN license in applicable state(s) required
• Multi-state licensure is required if providing services in multiple states
• Bilingual candidates strongly preferred
• 2+ years of experience with the pediatric population strongly preferred
• Certification as a Case Manager is preferred

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources