RN Pediatric Care Manager — Transform Care for Families

Blue Cross and Blue Shield of Massachusetts Inc.; Hingham (MA); Hybrid; USD 61,000 - 74,000; Full time

Benefits offered by this job

Medical/dental/vision insurance

401(k) plan

Well-being benefits

Job summary

Blue Cross Blue Shield of Massachusetts Inc. seeks a Pediatric Care Manager to coordinate and optimize care for members with rising health risks or complex needs in a pediatric population.

The role combines independent decision-making with collaboration across medical and behavioral health teams and care managers to improve outcomes. The ideal candidate has 3–5 years of pediatric health care experience, active MA licensure (RN or PT), and proficiency with multiple IT systems to support case

Qualifications

• 3–5 years relevant pediatric clinical health care experience (inpatient or outpatient).
• Utilization Management experience preferred.
• Active licensure in Massachusetts is required, appropriate to position (RN/PT).

Responsibilities

• Engage members in appropriate plans of care and coordinate services.
• Interpret and apply case management criteria and document care plans.
• Review medications and counsel on side effects and mitigation strategies.
• Support seamless care transitions and collaborate with PCPs, physicians, therapists, and facilities.

Skills

Care coordination

Self-directed

IT systems proficiency

Cultural competence

Education

High school diploma

MA professional licensure (RN or PT)

Tools

IT systems

Job description

Blue Cross Blue Shield of Massachusetts Inc. seeks a Pediatric Care Manager to coordinate and optimize care for members with rising health risks or complex needs in a pediatric population.

The role combines independent decision-making with collaboration across medical and behavioral health teams and care managers to improve outcomes. The ideal candidate has 3–5 years of pediatric health care experience, active MA licensure (RN or PT), and proficiency with multiple IT systems to support case