Pediatric Care Manager

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.

Minimum Qualifications:

• NYS RN or
• LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)
• 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disable populations

Preferred Qualifications:

• Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing crisis situations.
• Fluency in Spanish, Korean, Mandarin, or Cantonese.
• Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors.
• Knowledge of InterQual and LOCADTR.
• Experience managing member information in a shared network environment using paperless database modules and archival systems.
• Experience and knowledge of the relevant product line
• Relevant work experience preferably as a Care Manager
• Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
• Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
• Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems

Hiring Range:

• Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480
• All Other Locations (within approved locations): $71,594 - $106,080

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.