Pediatric Shift Care Clinical Care Specialist
3 weeks ago
We are seeking a highly skilled Pediatric Shift Care Clinical Care Specialist to join our team at AmeriHealth Caritas Health Plan. As a key member of our clinical review team, you will play a critical role in ensuring the delivery of high-quality, patient-centered care to our pediatric members.
Key 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 member medical, behavioral, and social needs, and obtain additional information as needed to support medical necessity.
- Collaborate with physicians, home care agencies, and other stakeholders to ensure timely and effective 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 continuation of services until no longer needed or until the member's 21st birthday.
Requirements:
- 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.
- Working knowledge of MS Office, including Word, Excel, and Outlook, and Internet applications in Windows 10.
- Proficiency utilizing electronic medical record (EMR) and clinical documentation programs.
What We Offer:
- Diversity, Equity, and Inclusion: Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
- Flexible work solutions, including remote options and hybrid work schedules.
- Competitive pay and comprehensive benefits package.
- Opportunities for professional growth and development.
About AmeriHealth Caritas Health Plan:
We are a national leader in health care solutions, dedicated to helping people get care, stay well, and build healthy communities. Our comprehensive, outcomes-driven care model delivers integrated managed care products, pharmaceutical benefit management, and specialty pharmacy services, among others.
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