Pediatric Case Manager RN

Actalent is seeking a Remote RN Case Manager with pediatric acute experience to manage complex and chronic conditions across a pediatric population within a managed care environment. This role partners with providers, hospitals, and multidisciplinary teams to coordinate care, close gaps in services, and improve health outcomes while reducing avoidable utilization.

Responsibilities

• Conduct comprehensive needs assessments for pediatric members, including those with complex and chronic conditions, to identify medical, behavioral, and social needs.
• Stratify member risk levels and prioritize outreach and interventions based on acuity and clinical urgency.
• Develop, implement, and regularly update individualized care plans aligned with evidence-based guidelines and best practices.
• Coordinate care across providers, hospitals, and multidisciplinary teams to ensure seamless transitions and continuity of care.
• Review inpatient census activity to identify members who are hospitalized or recently discharged and require follow-up.
• Coordinate and facilitate safe and timely hospital discharges, including arranging follow-up appointments, services, and resources.
• Conduct proactive outreach to high-risk and medically fragile pediatric members and their families to address gaps in care and support adherence to treatment plans.
• Provide disease-specific education to patients and families to promote self-management, understanding of conditions, and adherence to medications and therapies.
• Collaborate with utilization management and care coordination teams to ensure services are medically necessary, appropriate, and cost-effective.
• Ensure case management activities comply with Medicaid requirements, PCMH standards, and internal organizational policies and procedures.
• Document assessments, care plans, interventions, and outcomes accurately and timely in care management documentation systems and electronic health records.
• Use motivational interviewing techniques and patient education strategies to engage families and support behavior change.
• Communicate clearly and professionally with members, families, providers, and internal teams using strong written and verbal communication skills.
• Work independently in a fast-paced, outcomes-driven environment while managing a caseload of pediatric members with varying levels of complexity.
• Leverage Microsoft Office tools and care management systems to track progress, report outcomes, and support data-driven decision making.

Requirements

• Active Florida Registered Nurse (RN) license.
• 3–5 years of clinical nursing experience.
• Hands-on case management experience, preferably within managed care or population health settings.
• Pediatric (PED) or Pediatric Intensive Care Unit (PICU) clinical experience supporting medically complex populations.
• Experience conducting needs assessments and developing individualized care plans.
• Experience closing gaps in care and coordinating services across multiple providers and settings.
• Strong understanding of Medicaid regulations, utilization management, and care coordination processes.
• Strong written and verbal communication skills.
• Ability to work independently in a fast-paced, outcomes-driven environment.
• Proficiency with Microsoft Office.
• Experience using care management documentation systems.

Schedule

• Monday through Friday, 8:00 AM to 5:00 PM with a 30-minute lunch and flexible start times.
• Hybrid/remote work model based in Florida, with onsite presence required on Tuesdays for local candidates and additional onsite requirements as needed.
• Initial training requires onsite orientation on Mondays, training on Tuesdays and Thursdays, and EPIC training on Wednesdays. After training, the role transitions to primarily hybrid with quarterly onsite visits in Sunrise, Florida.

Pay

$40.00 - $44.00/hour.

Benefits

• Medical, dental, and vision insurance.
• Critical Illness, Accident, and Hospital insurance.
• 401(k) Retirement Plan with pre-tax and Roth post-tax contribution options.
• Life Insurance (Voluntary Life & AD&D for employee and dependents).
• Short-term and long-term disability.
• Health Spending Account (HSA).
• Transportation benefits.
• Employee Assistance Program.
• Time Off/Leave (PTO, Vacation, or Sick Leave).

Eligibility requirements apply to some benefits and may depend on job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms.

About the Role

This is a Contract to Hire position based in Orlando, FL, with a hybrid work arrangement. The role emphasizes collaboration with multidisciplinary teams, use of care management documentation systems, and regular interaction with electronic health record platforms such as EPIC.