NICU/ Pediatric Case Manager, RN/ LVN

The Pediatric Nurse Case Manager (CM) is responsible for the assessment, planning, intervention, monitoring and evaluating of all Pediatric members.  The goal of the Pediatric CM is to effectively coordinate the care coordination needs of the member including collaborating with the Interdisciplinary Care Team, the member, family, and providers.  The Pediatric CM delivers case management services that are patient centered and assist the member and the family to achieve optimum health outcomes throughout the care continuum.  

 

Essential Duties and Responsibilities include the following:

 

• Establishes and maintains a relationship with the member and the family where the CM prioritizes and addresses the medical, social, functional, and psychosocial needs of the member.
• Coordinate member/family/caregiver teaching, referrals and follow-up care for pediatric members.
• Demonstrate knowledge and understanding on the limited resources for this population, the uniqueness of the member’s social support, and family dynamics in order to address the needs of the member.
• Documents member assessment and reassessment, individualized care plans, and other pertinent information completed in the member’s medical record in accordance with nursing standards, and company policies and procedures
• Develops an outcome-based plan of care, based on the member/family/caregiver input, HRA, medical records and assessment of member needs. Implements and evaluates the plan of care as often as needed as evidenced by documentation in the Member’s case file.
• Identifies the appropriate members to participate in the interdisciplinary case round (ICT) process. Prepares the necessary summary information to present to the team. Invites the Member, and at Member’s discretion, caregiver and/or family, to attend ICT meeting when convened.
• Communicates the Care Coordination process to Member/family/physicians and other
• Care Coordination team members explaining Member’s right to refuse care coordination and accept as desired and the benefits of the program to the Member/family/physicians at no cost to the Member.
• Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
• Functions as care coordinator between Member, primary care provider, and multidisciplinary care team.
• Demonstrates the ability to advocate for member and the family to meet the needs of the member.
• Educates the member/caregiver on the transition process and how to reduce unplanned transitions of care
• Manages transition of care from the sending to receiving settings ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member’s health care status changes.
• Addresses psychosocial needs of the members and family and makes appropriate referral to Interdisciplinary Care Team members as needed.
• Collaborates and communicates with all members of the healthcare team (concurrent review, pre-authorization, PCP/SPC, Social Services) to coordinate the continuum of care of developing plans for management of each case.
• Responsible for the coordination of post-discharge clinic appointments, medication reconciliation, PCP and SPC visits, transportation and communication assistance
• Identifies community resources to address needs based on assessment and makes appropriate referrals to appropriate resource
• Initiates home or hospital visits/rounds as needed to assess patient progress and meet with appropriate members of the patient care team
• Other duties as assigned

The pay range for this position at commencement of employment is expected to be between $34.50-40.00 (LVN) and $45-50.00 (RN) hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

 

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

 

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

 

If hired, employee will be in a