Pediatric RN Case Manager

Position Purpose: Works with youth members, parents/legal guardians and providers to achieve better behavioral, developmental and physical health appointment and care compliance to prevent the incurrence of high cost or poor clinical outcomes; works to target the reduction of case complications through identification of high risk triggers; coordinates care from a family-driven, youth guided approach, maintaining clear communication channels with the member and their family, providers, Health Homes and plan staff.

Adhere to clinical standards of care for children including but not limited to SED, Developmentally Disabled, Medically Fragile and foster care populations, through collaboration with providers; practice and adhere to departmental and State guidelines for HCBS and State Plan Services; monitor for appropriate outcomes.
Provide Utilization Management and Care Management support for identified member groups and specific services.
Communicate with youth members, parent/legal guardian or other identified family, and medical and community based service personnel in a timely fashion, as necessary, to facilitate a mutually desired outcome.
Work collaboratively with medical utilization management and care management teams in order to best support members holistic needs.
Collaborate with the Physician Advisor; assess appropriateness and effectiveness of recommended treatment and care.
Create and manage electronic member files to document member data including treatments and progress.
Attend educational workshops; review professional publications to stay abreast of current trends; establish personal networks and participate in professional societies to maintain professional and technical knowledge.
Education/Experience: Master’s degree or equivalent required; Bachelor’s degree required with RN license. One to three years clinical experience with children, families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations is required; assessing treatment needs and making recommendations that impact desired outcomes while maintaining high quality of care. Three to five years related experience preferred. Business Analysis Knowledge: Skilled to work in a fast paced environment. Must have strong analytical and problem solving skills. Computer Systems: Possesses basic skills and comfort with navigating multiple computer based programs, applications and databases such as Microsoft Word, Excel, electronic health records and internet navigation. Customer Service: Skilled to communicate with all levels of management, internal and external customers. Ability to work well as a member of a team or alone. Effective Business Communication: Skilled in communicating with technical and business constituencies in writing effective business specifications and requirements. Proficiency in Microsoft Office: Excel, Word, Access; Lotus Notes; Internet.

License/Certification: NYS LMSW, LCSW, LMHC or RN License required

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.