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. Identifying and monitoring pediatric patient needs around care coordination and care management.

1. Performs ongoing telephonic and face-to-face case management activities of assessment, problem identification, planning, implementation, coordination, monitoring and evaluation of pediatric patients.
2. 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.
3. 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.
4. 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.
5. Promote patient wellness and autonomy through advocacy, communication, education and identification and referral to community resources or other case/disease management programs.
6. Collaborate with healthcare professionals throughout the care continuum to facilitate the transition of the patient to the most appropriate level of care.
7. 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.
8. 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.
9. Performs assigned work safely, adhering to established department safety rules and practices in a timely manner.
10. Acts as the liaison regarding care management programs, services, and activities by working with providers, payors, consultants, and other staff.

Requirements-

Bachelor's Degree

Licensure for Delaware and Pennsylvania Required

Case Management Certification Preferred: CCM, ACM-RN

Minimum of 1 Year relevant experience