Pediatric LPN Case Manager Position Available In [Unknown county], Florida

Job Title:

Care Navigator Job Description Under the oversight of the Medical Director, the Care Navigator assesses, plans, implements, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. The role involves developing or contributing to the development of personalized care plans for members and educating them and their families/caregivers on available services and benefit options to improve healthcare access and ensure high-quality care through advocacy and care coordination. Responsibilities Develop and contribute to ongoing care plans/service plans. Identify and coordinate with providers, specialists, and community resources needed for care. Manage and coordinate between members, their families/caregivers, and the care provider team to ensure timely access to identified services. Monitor progress towards care plan goals, member status, or changes in condition, and collaborate with healthcare providers for plan revisions or additional evaluations. Provide psychosocial and resource support to members/caregivers and care managers to access local resources or services such as employment, education, housing, food, independent living, and foster care. Identify problems or barriers to care coordination and implement appropriate care management interventions for members with higher care needs. Review referral information and intake assessments to develop or assist in the development of appropriate care plans for members with higher care needs. Collaborate with healthcare partners to facilitate member care and determine if care plan revisions are needed. 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 members’ needs and collaborate with providers or resources as appropriate. Provide education to care managers and/or 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/or serve as a preceptor for newly hired staff. Perform other duties as assigned by the people leader to meet member and/or business needs. Essential Skills Bachelor’s degree and 4-6 years of related experience. Graduation from an Accredited School of Nursing if holding clinical licensure. Current state clinical license preferred. Experience in case management, care management, managed care, and insurance. Experience working with the pediatric population, specifically 2 years. Strong communication and interpersonal skills. Ability to work collaboratively with a diverse range of contacts. Additional Skills & Qualifications FL LPN License Knowledge of ASD and related services is a plus. Work Environment The role may require on-site visits to assess members’ needs and collaboration with healthcare providers. The work involves compliance with state, federal, and third-party payer regulations and may include providing education to care managers, members, and their families/caregivers. The work environment values strong communication and interpersonal skills and the ability to work collaboratively with a diverse range of contacts.