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Pediatric Nurse Case Manager I
Elevance Health. Perform care management within the scope of licensure for members with complex and chronic care needs .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in care management for members with complex and chronic needs, including assessment, care plan development, and coordination of services. Proficient in bilingual communication and holds a valid RN license in Florida, with a focus on pediatric clinical experience.
Highest-signal resume keywords
RN License in FloridaPediatric Clinical ExperienceCare Plan DevelopmentBilingual Communication in Spanish and EnglishCertification as a Case Manager
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care ManagementAssessmentCare Plan ImplementationMonitoring and EvaluationNegotiation of Reimbursement RatesHospital Discharge Planning
Soft Skills
CommunicationCoordinationProblem Resolution
Tools & Technologies
Computer Savvy
Certifications & Qualifications
Certification as a Case Manager
Industry Keywords
Chronic Care ManagementPediatric CareHealth Needs AssessmentAuthorization and ReferralsMember Access to Services
About the role
Key responsibilities & impact- Perform care management within the scope of licensure for members with complex and chronic care needs
- Assess members and develop, implement, coordinate, monitor, and evaluate care plans
- Ensure member access to services appropriate to their health needs
- Conduct assessments to identify individual needs and care management objectives
- Facilitate authorizations and referrals within the benefits structure or through extra-contractual arrangements
- Coordinate internal and external resources to meet identified needs
- Monitor and evaluate care plan effectiveness and modify plans as necessary
- Interface with Medical Directors and Physician Advisors on care management treatment plans
- Negotiate reimbursement rates, as applicable
- Assist with provider, claims, or service issue resolution
- Perform duties telephonically or on-site, including hospital discharge planning
- Visit members in person within Orlando, Florida
Requirements
What you’ll need- BA/BS in a health related field and minimum of 3 years of pediatric clinical experience; or any combination of education and experience providing an equivalent background
- Current, unrestricted RN license in the state of Florida
- Bilingual communication skills in Spanish and English strongly preferred
- Certification as a Case Manager preferred
- Computer savvy
- Must reside within a reasonable commuting distance from the posting location unless accommodation is granted as required by law
- Required to visit members in person within Orlando, FL
- Monday–Friday availability, 8:00 am to 5:00 pm EST
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Hybrid workforce strategy
- COVID-19 and Influenza vaccination coverage/requirement for certain patient/member-facing roles