Case Manager I (Pediatric/Adolescent/Youth/NICU/Perinatal)

Case Manager I (Pediatric/Adolescent/Youth/NICU/Perinatal) Job Category: Care Management Requisition Number: CASEM002792 Apply now Posted : February 10, 2026 Full-Time Salary Range: $78,960 USD to $122,390 USD Locations Showing 1 location Remote Workers Washington Remote Washington State Remote Seattle, WA 98101, USA Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration. Our commitment is to: Strive to pply an equity lens to all our work. Create an equitable work environment. About the Role Responsible for the operational delivery of the plan's case management and coordination programs and processes. Provides case management services for CHPW Pediatric/Adolescent/NICU/Perinatal members with short term, long term, stable, unstable, and predictable course of illness, and/or highly complex medical/behavioral and social conditions. The goal is to improve members' quality of life and ensure cost-effective outcomes by using internal and community-based resources. The Case Manager level will be determined by the hiring manager based on education, previous experience, and demonstrated leadership skills. Qualifications Have a Bachelor’s degree in nursing, or a master’s degree in social work and/or related behavior health field (preferred) Possess Current, unrestricted license in the State of Washington as a registered nurse (RN) (required) OR Current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required), OR Current, unrestricted license in the State of Washington as a Mental Health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) (required) Have a minimum of one (1) year case management, home health or discharge planning experience; or a combination of education and experience which provides an equivalent background required OR Have a minimum of one (1) year facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse/substance abuse disorder treatment experience, required; or equivalent combination of education and experience and/or working with children and families. Experience with those who have disabilities and knowledge of Child and Families Services Have a minimum three (3) years of clinical experience in an acute care and/or outpatient setting (required) Experience and proficiency with Microsoft Office products Possess a Case Management Certification (preferred) Have Bilingual abilities (preferred) Essential Functions and Roles and Responsibilities Perform telephonic case management for members with acute, chronic, and complex needs. Advocate on behalf of members and facilitate coordination of resources required to help members reach optimum functional levels and autonomy within the constraints of their disease conditions. Work within a multi-functional team to connect with providers, members, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs and ensure access to appropriate services to achieve positive health outcomes. Assess, evaluate, plan, implement, and document care of members within the organization’s clinical database system, in accordance with organizational policies and procedures. Assess members, including identifying and coordinating access to the appropriate level of care and treatment. Use the assessment information to assign the appropriate risk and complexity level, and create and document a care plan in coordination with the member, family and health team input. Initiate a plan of care based on member-specific needs, assessment data and the medical/behavioral plan of care. Goals for members are measurable and developed in conjunction with the patient/family to improve quality of life. Plan care in collaboration with members of the multidisciplinary team, and consider the physical, behavioral, cultural, psychosocial, spiritual, age specific and educational needs of the member in the plan of care. Review and revise the plan of care with the interdisciplinary care team to reflect changing member needs based on evaluation of the members’ status, and/or as a result of reassessment. Implement the plan of care through direct member care, coordination, and delegation of the activities of the health care team. Promote continuity of care by accurately and completely communicating to health care team the status of members for whom care is provided. Engage community resources where applicable. Conduct interdisciplinary care team meetings with the member/family to assess care plan and recommend adjustments as indicated. Continuously evaluate members’ progress towards goals, identify potential barriers to attaining goals and expected outcomes in collaboration with other health care team members. Document all case activity using the CHPW care management system and follow documentation standards and protocols. Collaborate with the Transition of Care (TOC) team if a member is hospitalized. Serve as a liaison at various local and statewide meetings and/or workgroups and provide clinical support to providers’ network to enhance integrated care coordination. Assess barriers to care and assist members and health care team to address concerns. Implement developed workflow activities and activities for designated programs. Conduct member case management in the field at Provider(s) office, member’s home, inpatient medical or psychiatric hospitals, skilled nursing facilities, adult family homes, or in a community setting. Attend member appointments or care conferences in collaboration with the member's care team when indicated. This position may require traveling on behalf of the Company and working in the field. It is essential that a current driver’s license, proof of insurance and an acceptable driving record are maintained. Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards. Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion. Knowledge, Skills, and Abilities Knowledge of, and experience with, community resources preferred Knowledge of Medicare and Medicaid regulations Experience in care management workflow systems Effective verbal and written communication skills Organizational, time management, and project management skills Ability to work independently Comfortable presenting in a group setting Perform all functions of the job with accuracy, attention to detail and within established timeframes. Meet attendance and punctuality standards Hiring Process Criteria Complete and successfully pass a criminal background check Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees. Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency Vaccination requirement (CHPW offers a process for medical or religious exemptions) Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation. Compensation and Benefits The position is FLSA Exempt and is not eligible for overtime has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors. CHPW offers the following benefits for Full and Part-time employees and their dependents: Medical, Prescription, Dental, and Vision Telehealth app Flexible Spending Accounts, Health Savings Accounts Basic Life AD&D, Short and Long-Term Disability Voluntary Life, Critical Care, and Long-Term Care Insurance 401(k) Retirement and generous employer match Employee Assistance Program and Mental Fitness app Financial Coaching, Identity Theft Protection Time off including PTO accrual starting at 17 days per year 10 standard holidays, 2 floating holidays Compassion time off, jury duty Sensory/Physical/Mental Requirements Sensory* Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance. Physical* Extended periods of sitting, computer use, talking, and possibly standing Mental Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines. Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation. Preferred Attributes Innovative: Consistently introduces new ideas and demonstrates original thinking Enthusiastic: Shows intense and eager enjoyment and interest Team Player: Works well as a member of a group Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well Self-Starter: Inspired to perform without outside help Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Community Health Plan of Washington