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Pediatric Shift Care Clinical Care Specialist
2 months ago
We are seeking a highly skilled and compassionate Registered Nurse to join our team as a Clinical Care Reviewer for Pediatric Shift Care. As a key member of our team, you will play a critical role in ensuring the delivery of high-quality, patient-centered care to our pediatric members.
Responsibilities- Manage requests for pediatric shift care services, including skilled nursing and home health aide services, medical daycare, and pediatric residential facilities.
- Conduct comprehensive assessments of members' medical, behavioral, and social needs, using clinical knowledge and professional judgment to inform decision-making.
- Collaborate with physicians, home care agencies, and other stakeholders to ensure seamless care coordination and timely delivery of services.
- Present cases to the Medical Director for medical necessity review and ensure approved services are provided in a timely manner.
- Work collaboratively with Special Needs/Pediatric Shift Care Case Managers to ensure the continuation of services until they are no longer needed or until the member's 21st birthday.
- Current, active, and unrestricted Registered Nurse licensure in Pennsylvania.
- Graduate from an accredited school of nursing. Bachelor's Degree in Nursing preferred.
- 3+ years providing direct patient care as a Registered Nurse working with medically fragile pediatric patients in a clinical setting.
- 3+ years of Utilization Management experience, preferably within a managed care organization.
- Experience utilizing evidence-based clinical decision support tools, such as InterQual, desired.
We offer a comprehensive benefits package, including flexible work solutions, competitive pay, paid time off, health insurance coverage, and tuition reimbursement. Our company values diversity, equity, and inclusion, and we strive to create a workplace where everyone can feel valued, supported, and comfortable to be themselves.
