Pediatric Clinical Care Manager (RN) - Flexible Location

Responsibilities

• Aid members in transitioning care between healthcare facilities, sharing clinical information and care plans.
• Engage members to develop personalized care plans in collaboration with primary care providers, promoting healthy lifestyles and reducing unnecessary ER visits and hospital readmissions.
• Coordinate and modify care plans with members, caregivers, PCPs, specialists, community resources, and behavioral health contractors.
• Review and address medication adherence issues with members and providers.
• Refer members to Comprehensive Medication Reviews and appropriate case management, health management, or lifestyle programs.
• Engage members in education or self-management programs and provide educational materials.
• Contact members with gaps in preventive health care services and assist them in scheduling required screenings or diagnostics.
• Assist members in scheduling follow-up appointments after emergency room visits or hospitalizations.
• Plan standards and identify trends and opportunities for improvement based on interactions with members and providers.
• Conduct comprehensive face-to-face assessments covering medical, behavioral, pharmacy, and social needs.
• Update and communicate care plans following interdisciplinary team reviews and recommendations.
• Support families during the transition from pediatric to adult care.

Qualifications

• Bachelor of Science in Nursing (BSN) preferred.
• Minimum of 2 years of experience in a clinical setting and case management nursing.
• Minimum 1 year of health insurance experience.
• Pediatric nursing experience highly preferred.
• 1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management.
• Excellent organizational and communication skills.
• Computer proficiency.