Pediatric Care Manager
Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
Position Purpose: The Pediatric Care Manager is responsible for member specific care planning and care coordination of pediatric, CRS, and NICU members with high risk complex needs, using a comprehensive, culturally sensitive approach designed to meet the immediate and ongoing needs of infants and children in the population we serve. This position provides members with care management interventions that promote access to care and community resources.
- Review, screen, prioritize, and expedite as appropriate all pediatric referrals received
- Identify children with Specials Health Care needs who have a potential diagnosis(s) eligible for the Children Rehabilitative Services Program (CRS) and NICU graduate members who require Pediatric/NICU Care Management services
- Perform telephonic, age appropriate assessment of member needs and address these needs to remove any barriers in achieving optimal behavioral and medical health status
- Act as a liaison to facilities, providers and/or members/parents/guardians related to issues in care management and coordination of services
- Encourage members towards self-advocacy, self-management, and healthy lifestyle changes
- Educate members/parents/guardians on the importance of good health and following up with the Primary Care Physician on a regular basis
- Complete member surveys, assessments, and care plans
- Request and review medical records
- Provide and coordinate community resources and referrals
- Provide member/parent/guardian with education on disease processes
- Collaborate with the Interdisciplinary Team to incorporate best practices, assess outcomes and develop individualized care plans
- Develop and monitor the member’s care plan goals for progress and outcomes
- Accurately document member’s care management plans, authorizations, assessments, and levels of care
- Participate in ICT meetings as scheduled
- Review pediatric/NICU referrals for possible eligible CRS conditions, request supporting medical documentation, and submit applications to CRS for review
- Communicate to the PCP and specialty offices CRS enrollment, help members contact the CRS Clinic and schedule future appointments In various clinics as per plan of care to ensure no delay in medical care
- Adhere to NCQA Standards
Job Status: Full Time
Job Reference #: R485