What are the responsibilities and job description for the Medical Case Manager - Pediatrics position at SUNSHINE ENTERPRISE USA LLC?
Job Description
Medical Case Manager - Pediatrics
Company Overview : Our client is a leading healthcare located in Orange, CA, seeking a medical case manager, who will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes for all members along with focus on members under 21 years of age.
Position Summary : The successful candidate should hold a current, unrestricted registered nurse (RN) license to practice in the state of California, holds a bachelor's degree in nursing, and has 3 years of clinical experience dealing with pediatric patients.
Work Duration : Up to 6 months
Work hours : 8 am - 5 pm, M-F
Position Responsibilities :
- Assesses member needs using a standardized health needs assessment or health risk assessment.
- Conduct post-discharge assessments to identify and address member needs, including physical, functional, social, and psychological aspects, as well as cultural, linguistic, and caregiver support.
- Develop and implement personalized care plans with SMART goals, updating them regularly based on the member's condition and progress.
- Schedule follow-ups to monitor progress, identify obstacles, and ensure quality of care according to department standards.
- Coordinate with members, families, providers, and community resources to align care and services, including referrals to behavioral health and LTSS as needed.
- Communicate with physicians, specialists, and other agencies to ensure seamless care coordination.
- Facilitate and participate in interdisciplinary meetings, collaborating with internal teams for case resolution.
Identify cases requiring further review, routing them to the appropriate authority and closing them in accordance with procedures.
Experience & Education :
Necessary Attributes :
Please see HR for information on physical demands and work environment of this job.
Sunshine Enterprise USA is an "Equal Opportunity Employer-Minorities, Females, Veterans and Disabled Persons"
