Pediatric Case Manager RN

Job Description Job Description 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 envi #J-18808-Ljbffr Actalent