Clinical Case Manager

Actalent is Hiring a Remote RN Case Manager!! Must Have Pediatric Acute Experience! Job Description 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 position partners closely with providers, hospitals, and multidisciplinary teams to coordinate care, close gaps in services, 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. This role operates in compliance with Medicaid requirements, patient‑centered medical home (PCMH) standards, and organizational policies to support cost‑effective care delivery and enhance quality of life for members. Responsibilities Conduct comprehensive needs assessments for pediatric members, including those with complex and chronic conditions, to identify medical, behavioral, and social needs. Stratify member risk levels and prioritize outreach and interventions based on acuity and clinical urgency. Develop, implement, and regularly update individualized care plans aligned with evidence‑based guidelines and best practices. Coordinate care across providers, hospitals, and multidisciplinary teams to ensure seamless transitions and continuity of care. Review inpatient census activity to identify members who are hospitalized or recently discharged and require follow‑up. Coordinate and facilitate safe and timely hospital discharges, including arranging follow‑up appointments, services, and resources. Conduct proactive outreach to high‑risk and medically fragile pediatric members and their families to address gaps in care and support adherence to treatment plans. Provide disease‑specific education to patients and families to promote self‑management, understanding of conditions, and adherence to medications and therapies. Collaborate with utilization management and care coordination teams to ensure services are medically necessary, appropriate, and cost‑effective. Ensure case management activities comply with Medicaid requirements, PCMH standards, and internal organizational policies and procedures. Document assessments, care plans, interventions, and outcomes accurately and timely in care management documentation systems and electronic health records. Use motivational interviewing techniques and patient education strategies to engage families and support behavior change. Communicate clearly and professionally with members, families, providers, and internal teams using strong written and verbal communication skills. Work independently in a fast‑paced, outcomes‑driven environment while managing a caseload of pediatric members with varying levels of complexity. Leverage Microsoft Office tools and care management systems to track progress, report outcomes, and support data‑driven decision making. Essential Skills Active Florida Registered Nurse (RN) license. 3–5 years of clinical nursing experience. Hands‑on case management experience, preferably within managed care or population health settings. ePediatric (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 and coordinating services across multiple providers and settings. Strong understanding of Medicaid regulations, utilization management, and care coordination processes. Strong written and verbal communication skills. Ability to work independently in a fast‑paced, outcomes‑driven environment. Proficiency with Microsoft Office. Experience using care management documentation systems. Work Environment This role follows a hybrid/remote work model based in Florida. 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 for local candidates, with additional onsite requirements as needed. Orientation takes place onsite on Mondays for computer pickup, followed by onsite training sessions on Tuesdays and Thursdays and dedicated EPIC training onsite on Wednesdays. After the initial training period, the role transitions to a primarily hybrid arrangement with quarterly onsite visits in Sunrise, Florida. The environment emphasizes collaboration with multidisciplinary teams, use of care management documentation systems, and regular interaction with electronic health record platforms such as EPIC. Job Type & Location This is a Contract to Hire position based out of Orlando, FL. Pay and Benefits The pay range for this position is $40.00 - $44.00/hr. 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 Orlando,FL. Application Deadline This position is anticipated to close on Aug 24, 2026. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email View email address on click.appcast.io for other accommodation options. San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records. Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools. #J-18808-Ljbffr