Pediatric Care Manager I (RN)

Company: Sunshine State Health Plan
Location: Hialeah
Posted on: March 17, 2023

Job Description:

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

This role offers pediatric case management for members (0-21 years). Florida RN license needed. Work-from-home role with home visits in Collier County. Candidates must reside in Collier, Hendry, or Lee county.

Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care

Develop, assess and adjust, as necessary, the care plan and promote desired outcome
Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
Provide patient and provider education
Facilitate member access to community based services
Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems

Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.

Licenses/Certifications: Current state's RN license.For Sunshine Health (FL) Only: Employees supporting Florida's Children's Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel.

Additional Details:

Department: Children's Medical Services

Caseload: Pediatrics - Newborn to 21 years old. Caseload based on residence.

Territory: Collier County - Work-from-Home / Hybrid-remote

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Sunshine State Health Plan, Hialeah , Pediatric Care Manager I (RN), Executive , Hialeah, Florida