Pediatric Nurse Case Mgr I

IntelliResume; Florida; On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Medical benefits

Disability benefits

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Job summary

IntelliResume is seeking a Pediatric Nurse Case Manager I for Lake Mary, FL. The role focuses on care management for members with complex and chronic needs, developing and monitoring care plans to optimize health outcomes.

The ideal candidate holds a BA/BS in a health-related field, at least 3 years of pediatric clinical experience, and an active FL RN license. Case Manager certification is preferred, with full-time hours and competitive benefits.

Qualifications

• BA/BS in a health-related field is required.
• Minimum of 3 years of pediatric clinical experience is required.
• Current, unrestricted RN license in Florida is required.
• Certification as a Case Manager is preferred.

Responsibilities

• Conduct assessments to identify individual needs and develop care management plans.
• Implement care plans by facilitating authorizations/referrals within benefits structure.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans and modify as necessary.
• Interface with Medical Directors and Physician Advisors on care management treatment plans.
• Negotiate rates of reimbursement as applicable.
• Assist in problem solving with providers, claims, or service issues.

Skills

Care coordination

Clinical assessment

Problem solving

Education

BA/BS in a health-related field

Job description

About This Role

The Pediatric Nurse Case Manager I is responsible for performing care management for members with complex and chronic care needs, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care.

Highlights

• Location: Lake Mary, FL
• Schedule: Full-time, Monday – Friday: 8:00 am to 5:00 pm (EST)

What You’ll Do

• Conduct assessments to identify individual needs and develop specific care management plans.
• Implement care plans by facilitating authorizations/referrals within benefits structure.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans and modify as necessary.
• Interface with Medical Directors and Physician Advisors on care management treatment plans.
• Negotiate rates of reimbursement as applicable.
• Assist in problem solving with providers, claims, or service issues.

Requirements

Education:

• BA/BS in a health-related field required

Experience:

• Minimum of 3 years of pediatric clinical experience required

Licenses & Certifications:

• Current, unrestricted RN license in the state of Florida required
• Certification as a Case Manager preferred

Benefits

• Merit increases
• Paid holidays and Paid Time Off
• Medical, dental, and vision benefits
• Short and long-term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs and financial education resources

About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. They are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels who are passionate about making an impact on their members and the communities they serve.