The Care Management Nurse (RN) coordinates the utilization of pediatric healthcare resources, including transition planning, while facilitating the achievement of clinical, quality, financial and patient satisfaction goals across identified risk populations. Stratifies and/or validates patient level of risk during each transition process and interaction with the patient and family. Equity, diversity, and inclusion guide our growth and strategy. We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build a diverse and inclusive team environment.
Schedule and Location : Mon. - Fri. during normal business hours. Must be located in proximity to Nemours location in Dover, DE. This is a hybrid position with some time telecommuting and some time in the designated clinical locations.
Performs ongoing telephonic and/or embedded case management activities of assessment, problem identification, planning, implementation, coordination, monitoring and evaluation of pediatric patients.
Collaborates with patients, families and members of the multidisciplinary care team to develop a patient/family centered plan of care to meet identified patient care goals and outcomes.
Develop, implement, evaluate and revise case management care plans according to case management eligibility criteria, contractual guidelines and patient/family physical and psychological needs throughout the continuum of care.
Identify system issues that serve as barriers to care. Participate in development and implementation of strategies to remove barriers and promote resolution through coordination of a problem solving process.
Promote patient wellness and autonomy through advocacy, communication, education and identification and referral to community resources or other case/disease management programs.
Collaborate with healthcare professionals throughout the care continuum to facilitate the transition of the patient to the most appropriate level of care.
Demonstrate knowledge of utilization management and care coordination processes and current standards of care as a foundation for transition planning, complex case management and disease management activities.
Confers with Physician Advisor regarding complex cases requiring physician input regarding the treatment plan or physician to physician collaboration in the care of the pediatric patient.
Performs assigned work safely, adhering to established department safety rules and practices in a timely manner.
Acts as the liaison regarding care management programs, services, and activities by working with providers, payors, consultants, and other staff.
Qualifications:
Required: Licensed registered nurse (active and unrestricted in the State of Delaware and PA)
Preferred: Certified Case Manager (CCM), Case Manager, Certified (CMC) or Certified Professional in Health Care Quality (CPHCQ), expectation to obtain certification within 2 years of start
Preferred: Knowledge of models of case management and experience with how to transition care management functions from one model to another
Minimum of five (5) years pediatric nursing experience
Minimum of two (2) years of UM or Case Management experience
