Pediatric Case Manager

Pediatric Case Manager (Population Health & Concierge Care Coordination Care Coordinator, RN)

The Pediatric Case Manager (Population Health & Concierge Care Coordination Care Coordinator, RN) plays a critical role in managing complex and chronic conditions across a pediatric population within a managed care environment. This nurse collaborates closely with providers, hospitals, and multidisciplinary teams to coordinate care, close gaps, and improve health outcomes while reducing avoidable utilization. The Care Coordinator conducts comprehensive needs assessments, stratifies risk, and develops individualized care plans aligned with evidence-based guidelines. The role includes reviewing inpatient census activity, coordinating discharges, conducting outreach to high-risk members, and providing disease-specific education that empowers patients and families in self-management. This position operates in compliance with Medicaid requirements, patient-centered medical home (PCMH) standards, and organizational policies to support cost-effective care delivery and improve quality of life for members.

Responsibilities

• Conduct comprehensive needs assessments for pediatric members, including those with complex and chronic conditions, to identify clinical, social, and behavioral health needs.
• Stratify member risk levels using established criteria and tools to prioritize outreach and interventions for high-risk pediatric populations.
• Develop individualized, evidence-based care plans that address medical, psychosocial, and care coordination needs for pediatric members and their families.
• Review inpatient census activity regularly to identify members who are hospitalized or recently discharged and ensure timely follow-up.
• Coordinate hospital discharges by collaborating with providers, hospital staff, and community resources to support safe transitions of care.
• Perform proactive outreach to high-risk and medically fragile pediatric members and their caregivers to ensure engagement in care and adherence to treatment plans.
• Provide disease-specific education to patients and families to promote self-management, improve understanding of conditions, and support long-term health outcomes.
• Collaborate closely with multidisciplinary teams, including physicians, nurses, social workers, and other care team members, to align care plans and interventions.
• Ensure care coordination activities comply with Medicaid requirements, utilization management guidelines, and organizational policies.
• Support patient-centered medical home (PCMH) standards by facilitating coordinated, continuous, and comprehensive care for pediatric members.
• Document all case management and care coordination activities accurately and timely in care management documentation systems and electronic health records.
• Use Microsoft Office and care management systems to track outcomes, monitor progress, and report on quality and utilization metrics.
• Work independently in a fast-paced, outcomes-driven environment while managing a caseload of pediatric members with varying levels of complexity.
• Identify and close gaps in care by coordinating preventive services, follow-up appointments, and necessary referrals.
• Engage families and caregivers using strong communication and motivational techniques to encourage participation in care plans and adherence to recommendations.

Essential Skills

• Active Florida Registered Nurse (RN) license.
• Bachelor's Degree in Nursing (BSN required).
• Master's Degree in Nursing (MSN) preferred.
• 3–5 years of clinical nursing experience.
• Hands-on case management experience, preferably within managed care or population health.
• Pediatric (PED) or Pediatric Intensive Care Unit (PICU) clinical experience supporting medically complex populations.
• Experience conducting needs assessments and developing individualized care plans.
• Experience closing gaps in care for pediatric or complex populations.
• Strong understanding of Medicaid regulations, utilization management, and care coordination requirements.
• Strong written and verbal communication skills.
• Ability to work independently in a fast-paced, outcomes-driven environment.
• Proficiency with Microsoft Office applications.
• Proficiency with care management documentation systems.

Additional Skills & Qualifications

• Certified Case Manager (CCM) certification.
• Experience working with high-risk or medically fragile pediatric populations.
• Familiarity with patient-centered medical home (PCMH) standards and multidisciplinary team models.
• Experience with electronic health record (EHR) platforms such as EPIC or similar systems.
• Motivational interviewing experience.
• Patient and family education experience.

Work Environment

This role is based in Florida in a hybrid work environment. The schedule is Monday through Friday, 8:00 AM to 5:00 PM with a 30-minute lunch, and offers flexible start times. The position requires onsite presence on Tuesdays, with additional onsite requirements as needed. Orientation includes onsite attendance on Mondays for computer pickup, onsite training sessions on Tuesdays and Thursdays, and onsite EPIC training on Wednesdays. After initial training, the role transitions to a hybrid schedule with occasional onsite visits in Sunrise, Florida. The position is offered as a contract role with an expected duration of approximately 2 to 5 months, depending on business needs. The environment emphasizes collaboration with multidisciplinary teams, use of care management documentation systems, and electronic health records, while supporting a professional, outcomes-focused, and patient-centered culture.

Job Type & Location

This is a Contract position based out of Sunrise, FL.

Pay and Benefits

The pay range for this position is $40.00 - $44.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a hybrid position in Sunrise, FL.

Application Deadline

This position is anticipated to close on Jun 11, 2026.