Responsibilities:

Under the supervision of the Supervisor, Care Coordination, the Case Manager assumes the overall accountability for the identification of members appropriate for care coordination and/or case management program services.  Completes a comprehensive case management assessment and gathers pertinent information about the Member's needs by interviewing the M/C, appropriate family members, physicians, ancillary health professionals and others as necessary; some community facing visits may be required. Is responsible for the development of the Member's interdisciplinary individualized plan of care including short term and long term goals in collaboration with the M/C. Monitors and evaluates the M/C’s progress towards meeting goals and initiates appropriate interventions as necessary.  Serves as an advocate for the member and acts as a liaison between the Member and other community based agencies, facilities, providers, and practitioners in coordinating the Member's care.  Refers Member as appropriate for other services such as Special Needs and Pharmacy.   Pediatric case management experience recommended.

Education/ Experience:

• A bachelors (or higher) degree in a health related field 
• Current and unrestricted Registered Nurse Licensure in Pennsylvania
• 3 years of clinical, direct care experience working with pediatric patients within the shift care population.
• 3 to 5 years of Case Management experience, preferably telephonic with in a MCO, preferred.
• Certification as a case manager (as documented and accepted on URAC’s website@ www.urac.org) preferred
• Demonstrated proficiency working within a Windows 10 environment to include MS Office and electronic medical record and documentation programs.
• Valid driver’s license with car insurance