Description and Requirements

The Pediatric Care Manager plans and manages pediatric medical and/or behavioral care with members and their beneficiaries across the continuum of care. The Care Manager is assigned to a specific product line such as PHSP, Child Health Plus, etc. The Care Manager is responsible for applying care management principles when engaging members and health care team members through coordination of health care services.

This position is 100% Remote

• Adhere to standards of care for children including but not limited to developmentally disabled, medically fragile and foster care populations
• Develops a member centric plan of care through collaboration with member (as age appropriate), family, appointed guardian and the multi-disciplinary health care team (pediatricians, specialists, health homes, school or facility social workers and home or community-based service providers) to maximize the pediatric member's functional capacity through integrated collaborations.
• Documents all encounters with pediatric members, guardians, legal representatives, providers and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates plan of care based on member needs and goals, as appropriate.
• Conducts assessments telephonically to identify barriers and opportunities for intervention.
• Evaluates service authorizations and advocates to ensure alignment and execution of the member's care and physician treatment plan.
• Educates beneficiaries on available health care services within their coverage plan empowering self-management.
• Occasional overtime as necessary.
• Additional duties as assigned.