Pediatric Case Manager Position Available In Hillsborough, Florida

Actalent is Hiring Pediatric Case Managers! Job Description We are seeking experience Pediatric Case Managers to assess, plan, implement, and coordinate care management activities based on member needs. This role aims to provide quality, cost-effective healthcare outcomes by developing personalized care plans and educating members and their families/caregivers on available services and benefit options. The Pediatric Case Manager will advocate for and coordinate care to ensure members receive appropriate high-quality care. Responsibilities Develop or contribute to the development of ongoing care plans/service plans. Identify providers, specialists, and community resources needed for care. Coordinate and manage communications between members, families/caregivers, and the care provider team to ensure timely access to services. Monitor progress towards care plan goals and member status, collaborating with healthcare providers for care plan revisions as needed. Provide psychosocial and resource support to members, caregivers, and care managers to access local resources or services such as employment, education, housing, and more. Identify problems and barriers for care coordination and implement appropriate care management interventions for members with higher care needs. Review referral information and intake assessments to develop suitable care plans for members with higher care needs. Collaborate with healthcare partners to facilitate member care and determine if care plan revisions are necessary. Collect, document, and maintain all member information and care management activities to ensure compliance with state, federal, and third-party payer regulations. Perform on-site visits to assess member needs and collaborate with providers or resources as appropriate. Provide education to care managers, members, and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits. Serve as a Subject Matter Expert (SME) to support the care navigation team and mentor newly hired staff. Comply with all policies and standards. Perform other duties as assigned to meet member and business needs. Essential Skills Florida LPN License 2 years of experience working with Pediatric population Graduate from an Accredited School of Nursing if holding clinical licensure Experience in case management and managed care Strong communication and interpersonal skills Additional Skills & Qualifications Ability to work collaboratively with a diverse range of contacts Experience in care coordination and medical assessment Knowledge of ASD and related services Work Environment The Pediatric Case Manager will work in a collaborative environment, interacting with healthcare providers, members, and their families/caregivers. The role may involve on-site visits to assess member needs and coordination with various community resources. The position requires adherence to state, federal, and third-party payer regulations and compliance with all organizational policies and standards.