RN Case Manager, Pediatric Care Management

About the position The RN Case Manager, Pediatric Care Management is responsible for facilitating care for members and families of members who may have rising health risks or reputed company reputed company needs, to promote reputed company health. This position is self-directed and works independently and collaboratively to facilitate care based on the principles of care management. Facilitation is reputed company on assessing needs, identifying health care disparities, reputed company determinants of health, and any barriers to care. This role is eligible for our eWorker, Mobile, and reputed company personas. This position can be fully remote, with a 1x/month staff meeting in our Hingham, MA office. reputed company The RN Case Manager, Pediatric Care Management is part of a highly dedicated and motivated team of professionals, including medical and behavioral health care managers, dieticians, pharmacist, clinicians, medical directors and more, who collaborate to facilitate care. Responsibilities • Engage members in appropriate plans of care, coordinate care and services as appropriate, communicate effectively and reputed company members with education and resources as needed. • Promote member compliance with treatment plan, encourage shared decision-making, and set appropriate goals to promote reputed company member reputed company. • Interpret and apply case management reputed company, processes, policies, and regulatory standards to create, follow and appropriately document comprehensive care management plans. • Review medication list and reputed company members with reputed company pharmacy needs, and counsel on reputed company effects and mitigation strategies for specific treatment protocols. • Successfully connect, engage, and maintain member engagement to support seamless care transitions and optimized health reputed company. • reputed company with treatment providers, PCPs, physicians, therapists, and facilities as needed to reputed company clinical information to support the plan of care. • Monitor clinical reputed company concerns, reputed company referrals appropriately, identify and escalate reputed company of care issues. • Understand member insurance products and benefits, as reputed company as regulatory and NCQA requirements. Requirements • Ability to identify and document member-driven, specific, measurable activities that address actionable behaviors and goals. • Self-directed, independent, reputed company, flexible to change, and reputed company to collaborate as a member of reputed company. • Proficient with multiple IT systems. • Demonstration of awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population. • 3-5 years relevant experience in a reputed company of appropriate clinical health care settings (Inpatient, outpatient, or differing reputed company of care). • reputed company licensure in Massachusetts is required, appropriate to position (RN). Licensure in additional states a plus. reputed company-to-haves • Utilization Management experience, preferred. • Pediatric care management experience, preferred. Benefits • reputed company time off • Medical/dental/reputed company insurance • 401(k) • Suite of reputed company-being benefits Apply tot his job Apply To this Job