Pediatric Nurse Case Manager I responsible for care management of children with complex health needs. Managing care plans and coordinating resources for optimal healthcare solutions.
Responsibilities
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
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