Job Description

Position Purpose: The Pediatric Care Manager is responsible for member specific care planning and care coordination of pediatric and NICU members with high risk complex needs, using a comprehensive, culturally sensitive approach designed to meet the immediate and ongoing needs of infants and children in the population we serve. This position provides members with care management interventions that promote access to care and community resources.

Responsibilities:

  • Review, screen, prioritize, and expedite as appropriate all pediatric referrals received
  • Identify children with Specials Health Care needs who have a potential diagnosis(s) eligible for the Children Rehabilitative Services Program (CRS) and NICU graduate members who require Pediatric/NICU Care Management services
  • Perform telephonic and/or field, age appropriate assessment of member needs and address these needs to remove any barriers in achieving optimal behavioral and medical health status
  • Act as a liaison to facilities, providers and/or members/parents/guardians related to issues in care management and coordination of services
  • Encourage members towards self-advocacy, self-management, and healthy lifestyle changes
  • Educate members/parents/guardians on the importance of good health and following up with the Primary Care Physician on a regular basis
  • Complete member surveys, assessments, and care plans
  • Request and review medical records
  • Provide and coordinate community resources and referrals
  • Provide member/parent/guardian with education on disease processes
  • Collaborate with the Interdisciplinary Team to incorporate best practices, assess outcomes and develop individualized care plans
  • Develop and monitor the member’s care plan goals for progress and outcomes
  • Accurately document member’s care management plans, authorizations, assessments, and levels of care
  • Attend required meetings as scheduled
  • Review pediatric/NICU referrals for possible eligible CRS conditions, request supporting medical documentation, and submit applications to CRS for review
  • Communicate to the PCP and specialty offices CRS enrollment, help members contact the CRS Clinic and schedule future appointments In various clinics as per plan of care to ensure no delay in medical care

Post-NICU discharge outreach to the parents/families of the NICU graduate

  • Conduct initial and follow-up assessments within designated timeframes on NICU discharge notification referrals
  • Engage parents/families of NICU graduates with high risk complex care needs in the care management program

Assist with any other job duties identified by the department:

  • Assist with any reporting/tracking responsibilities
  • Assist other departments when necessary to ensure the member’s health care needs are met

Education / Experience / Other Requirements

Education:

  • Bachelor’s degree from an accredited Nursing School preferred

Certification or License:

  • Active, current, valid, unrestricted Arizona State Registered Nurse (RN)

Experience:

  • At least three (3) years in a pediatric health care setting
  • Experience coordinating patient care
  • HMO/Managed Care/ Medicare/Medicaid experience highly preferred

Specialized Knowledge and Skills:

  • Computer experience necessary
  • Effective time management and prioritization skills
  • Effective interpersonal and communication skills
  • Knowledge of Medicaid regulation and guidelines preferred
  • Knowledge of professional and community based resources helpful
  • Knowledge of medical terminology
  • Knowledge of CRS and/or NICU programs preferred
  • Knowledge and experience in pediatrics
  • Ability to problem solve and use critical thinking skills
  • Ability to work cooperatively, positively, and collaboratively in an interdisciplinary team
  • Ability to use electronic medical record and claims systems
  • Ability to work respectfully and positively with members, providers, and peers
  • Ability to handle multiple tasks and prioritize to adhere to deadlines and identified time frames
  • Ability to think analytically and make decisions

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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