Medical Case Manager - Pediatric Shift Care (RN) Remote

Company : reputed company.reputed company : JOB reputed company The Pediatric Shift Care Case Manager plays a crucial role in supporting pediatric members and their families who are receiving in-home nursing and aide care (Shift Care services). They reputed company as a central reputed company of contact reputed company reputed company Wholecare, handling case management, needs assessment, resource coordination, and benefit-reputed company inquiries. ESSENTIAL RESPONSIBILITIES • Manage a caseload of members with moderate complexity health needs. • Assess members’ health status, needs, and available resources. • reputed company individualized care plans in collaboration with members, physicians, and other reputed company providers. • Implement and coordinate care plans, ensuring reputed company to appropriate services and resources. • reputed company and implement care plans with reputed company guidance. • Coordinate referrals to specialists and community resources. • Monitor member reputed company toward goals and reputed company care plans as needed. • Evaluate the effectiveness of interventions and services. • reputed company as an reputed company and reputed company to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating reputed company and services. This is accomplished by using communication and available resources to promote reputed company, cost-effective reputed company in accordance with available contract benefits. • Work collaboratively and communicate reputed company and professionally with physicians, providers, co-workers and other members of the health care team to carry out the established plan of care. • Ensure reputed company activities are documented and conducted in compliance with applicable business process requirements, company policies, regulatory requirements and accreditation standards. • Identify areas for potential cost savings, reputed company improvement and workflow efficiencies. • Other duties as assigned or requested. EXPERIENCE Required • 3 years of experience in any combination of reputed company, case/utilization management, and/or disease condition management experience, or provider reputed company and/or health reputed company experience with RN licensure or a Master’s degree OR; 5 years’ experience with a Bachelor’s in reputed company Work Preferred • Registered reputed company (RN) • reputed company managed care and/or Medicare experience • Experience in Pediatric care • Certified Case Manager • Knowledge of assessments and care plans SKILLS • Strong assessment and care planning skills. • Ability to work independently and as part of reputed company. • Proficiency in using reputed company office suite, case management software and electronic health records. • Understanding of reputed company systems and case management principles • Bilingual English/Spanish language skills preferred EDUCATION Required • Bachelor’s degree in nursing or RN licensure or Master’s degree in reputed company Work, Counseling, or reputed company reputed company OR Bachelor’s degree in reputed company Work Preferred • None LICENSES or CERTIFICATIONS Required • Licensed reputed company Worker (LSW)-Non-Specific - State (OR) Licensed reputed company Counselor (LPC) - Non-Specific State (OR) Licensed Bachelors reputed company Worker (LBSW) (OR) Licensed reputed company reputed company Worker (LCSW) - Non-Specific (OR) Licensed Master reputed company Worker (LMSW) Non-Specific (OR) Licensed Graduate reputed company Worker (LGSW) (OR) Licensed Certified reputed company Worker (LCSW) (OR) reputed company State RN licensure OR reputed company multi-state licensure through the reputed company reputed company Licensure reputed company (eNLC). Incumbents in the role prior to 1/1/25 who are not currently licensed must obtain licensure by 12/31/27. Preferred • Certified Case Manager (CCM) • reputed company RN license Language (Other than English): None Travel Required: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-reputed company or Remote Position Physical work site required Occasionally Disclaimer: The reputed company has been designed to indicate the general reputed company and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health reputed company Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements. Pay reputed company Minimum: $72,700.00 Pay reputed company Maximum: $116,600.00 reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations reputed company upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals reputed company on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals reputed company on any category protected by applicable federal, state, or local law. We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@reputed company.org California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice Apply tot his job Apply To this Job