PDN Registered Nurse Case Manager

New PDN Company Looking for an RN Case Manager. This is a Huge Opportunity for Growth!

Sunshine Pediatric Day Center is a Prescribed Pediatric Extended Care (PPEC) facility delivering an innovative model of medical day care to medically complex and technology-dependent children. Our team of nurses, therapists, and child-care professionals provides skilled nursing care in a warm, engaging, family-centered

environment — giving kids a place to thrive during the day and giving caregivers the support they deserve.

The Opportunity

We are seeking a Registered Nurse Case Manager with PDN experience to serve as the clinical quarterback for each child enrolled

in our PDN program. This role owns the full lifecycle of patient care coordination — from referral and intake

through ongoing plan-of-care management, family education, physician communication, payer authorization,

and continuity across home, school, and outside providers.

If you love the relationship-building side of pediatric nursing, are highly organized, and want a role where you

advocate for kids and families while keeping clinical operations running smoothly — this is it.

Qualifications

Required:

• Active, unrestricted Registered Nurse (RN) license in the state of practice
• Current BLS/CPR certification (AHA preferred); PALS preferred
• Minimum 2–3 years of pediatric nursing experience (PPEC, pediatric home health, pediatric skilled nursing, PICU, NICU, or pediatric long-term care)
• Working knowledge of medically complex, technology-dependent pediatric care (trach, vent, G-tube, centrallines, seizure precautions, oxygen therapy)
• Strong understanding of pediatric plans of care, physician orders, and care coordination
• Excellent written and verbal communication skills
• Proficiency with EHR systems and Microsoft Office / Google Workspace

Preferred:

• BSN
• Prior case management, care coordination, or utilization review experience
• Experience working with Medicaid, Medicaid MCOs (STAR Kids, STAR), and private insurance for pediatric authorizations
• Familiarity with PPEC, pediatric medical day care, or pediatric skilled nursing regulations
• Bilingual (English/Spanish) a plus
• Case Management Certification (CCM, ACM, or RN-BC) a plus

Core Responsibilities

Intake, Referrals & Admissions

• Serve as the primary clinical point of contact for incoming referrals from hospitals, physicians, discharge planners, MCOs, and community partners
• Review referrals for clinical appropriateness and PPEC admission criteria
• Conduct or coordinate initial nursing assessments, gather medical records, and verify physician orders
• Partner with the Administrator and Director of Nursing on admission decisions and onboarding logistics

Plan of Care Management

• Develop, implement, and continuously update individualized plans of care for each enrolled child
• Ensure plans of care reflect current physician orders, diagnoses, equipment needs, medication regimens, therapy goals, and family preferences
• Conduct regular case reviews and reassessments at required intervals
• Coordinate with the medical director, PCPs, specialists, and therapists to keep care plans aligned and current

Care Coordination & Continuity

• Act as the clinical liaison between families, physicians, therapists, home health agencies, schools, programs, hospitals, and equipment vendors
• Coordinate transitions of care (hospital admissions/discharges, ER visits, specialist appointments, new diagnoses)
• Track upcoming appointments, immunizations, screenings, and follow-up needs
• Support families with navigating the healthcare system, accessing community resources, and understanding their child's care

Authorizations, Documentation & Compliance

• Obtain and maintain insurance authorizations and reauthorizations (Medicaid, MCOs, private payers);submit clinical documentation to support medical necessity
• Maintain accurate, timely, and HIPAA-compliant documentation in the EHR
• Ensure case files meet state, federal, and payer regulatory requirements
• Participate in chart audits, survey readiness, and quality improvement initiatives

Family Engagement & Education

• Build trusting, long-term relationships with families as their consistent point of clinical contact
• Educate caregivers on diagnoses, equipment, medications, and care plan goals
• Resolve concerns and escalations with empathy and professionalism
• Advocate for the child and family across the care contin