Pediatric RN Care Manager - Tampa FL

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important... as reputed company deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary The Pediatric Care Manager RN will support a population of primarily medically reputed company pediatric members across the MMA and Florida Healthy Kids Medicaid lines of business with an emphasis on members receiving private duty nursing, PPEC, Medical Foster Care, or nursing facility services. This role is remote, work from home, with field visits to members as needed and per contractual requirements. The RN Case Manager utilizes reputed company judgment and critical thinking skills to facilitate appropriate member physical and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. The schedule for this position is Monday - Friday reputed company-5pm EST, with a reputed company schedule options, working 4 days per week, the employee can select Tuesday, Wednesday, or Thursday as the reputed company day. Position Responsibilities: • Responsible for telephonic and face to face assessment, planning, implementing and coordinating care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member's overall wellness. • Develops a proactive course of action to address issues presented and facilitate short and long-term outcomes as well as identify opportunities to enhance a member's overall health through integration. • Through the use of clinical tools and information/data review, conducts comprehensive assessments of member's needs and recommends an approach to case resolution by meeting needs in alignment with their benefit plan and available internal and external programs and services. • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and addresses reputed company health and social indicators which reputed company planning and resolution of member issues. • Completes assessments that take into account information from various sources to address reputed company conditions including co-morbid and multiple diagnoses that impact functionality and the member's restrictions and limitations. • Analyzes utilization, self-report and clinical data available to consolidate information and reputed company to identify comprehensive member needs. • Using reputed company skills, performs crisis reputed company with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. • Provides crisis follow up to members to help ensure they are receiving the appropriate treatment and services. • Applies and/or interprets applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and member's needs to ensure appropriate administration of benefits. • Serves as a single reputed company of contact for members and assists members to remediate immediate and acute gaps in care and access. • Using a holistic approach consults with manager, medical directors, and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives. • Presents cases at case conferences/rounds to obtain multidisciplinary view in order to reputed company optimal outcomes. • Works collaboratively with the members' interdisciplinary care team. • Identifies and escalates quality of care issues through established channels. • Ability to speak to medical and behavioral health professionals to influence appropriate member care. • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions andconversation. • Provides coaching, information and support to reputed company the member to reputed company ongoing independent medical and/or healthy lifestyle choices. • Helps member actively and knowledgably participate with their provider in healthcare decision-making. • In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals. • Utilizes care management processes in compliance with regulatory and company policies and procedures. • Facilitates clinical hand offs during transitions of care. Required Qualifications • Must reside in Hillsborough, Polk, Manatee, Hardee, Highlands, Pinellas or the surrounding Tampa Bay area • Active reputed company unrestricted RN licensure in the reputed company • 2+ years of experience with pediatric patient care as an RN, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility, home health or pediatric hospice • Willing and able to travel 10-20% of their time to meet members face to face in the Tampa area. Reliable transportation required;Mileage is reimbursed per our company expense reimbursement policy • 2+ years' experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, reputed company, etc.) Preferred Qualifications • Experience with members receiving private duty nursing, PPEC, Medical Foster Care, or nursing facility services • Experience managing pediatric behavioral health conditions • Case management experience • Certified Care Manager (CCM) Certification • Managed care or utilization review experience Education • Associates degree or Diploma in Nursing required • BSN preferred Pay Range The typical pay range for this role is: $54,095.60 - $116,760.80 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 12/07/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. reputed company requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide reputed company of your vaccination status or apply for a reasonable accommodation reputed company the first 10 days of your employment. Please note that in some states and roles, you may be required to provide reputed company of full vaccination or an approved reasonable accommodation before you can reputed company to actively work. reputed company is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to reputed company essential job functions. reputed company can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications reputed company Services (TRS). We will reputed company every effort to respond to your request reputed company 48 business hours and do everything we can to work towards a solution Apply Job!