Pediatric Nurse Case Mgr I
Core
A field-based pediatric nurse case manager who assesses, develops, implements, coordinates, monitors, and evaluates care plans for members with complex and chronic care needs, optimizing healthcare across the care continuum.
Role type
Pediatric Nurse Case Manager (Field-Based)
Builds
Individualized care management plans and care coordination for pediatric members with complex/chronic conditions
Domain
Healthcare / Pediatric Care Management
Deliverable
client delivery
Required skills
Pediatric clinical assessment, care plan development, care coordination, authorization/referral facilitation, provider negotiation, discharge planning, care plan monitoring and evaluation
Preferred skills
Bilingual communication (Spanish/English), Case Management certification, Computer proficiency
Technologies
Electronic health records (implied via computer savvy and care plan management)
Responsibilities
Conduct assessments to identify individual needs and develop specific care management plans; Implement care plans by facilitating authorizations and referrals; Coordinate internal and external resources to meet identified needs; Monitor and evaluate effectiveness of care management plans and modify as necessary; Interface with Medical Directors and Physician Advisors on treatment plans; Negotiate rates of reimbursement; Assist in problem solving with providers regarding claims or service issues
Seniority
Individual Contributor (IC), Entry-to-Mid Level