🕒 2 days ago
Coordinate patient care by assessing needs, reviewing medical necessity and level of care, guiding patients through treatment decisions, and communicating with families, clinicians, insurers, and facility staff.
Newborn/Pediatric Nurse Care Manager
📅 Mar 7, 2025
NursingPediatric CareNewborn CareCare Management
📜 Description
- Provide coordinated, patient-centered care management by phone or video.
- Develop care plans with members and the multidisciplinary care team, supporting progress toward health goals.
- Help members navigate complex conditions, treatment pathways, benefits, and the healthcare system.
- Coordinate care with members’ local providers and arrange clinical or social resources.
- Provide longitudinal follow-up and support during acute episodes, including hospitalizations and rehabilitation stays.
🛠️ Requirements
- Bachelor of Science in Nursing (BSN) required.
- Minimum of 5 years of nursing experience, including 2+ years in a pediatric setting.
- 2+ years of care, case, and disease management experience; health plan, health navigator, or TPA experience preferred.
- Active Compact RN license in good standing in your state of residence; must reside in a compact NLC state.
- Willingness to obtain and maintain licenses in multiple states; active, unrestricted California RN license preferred.
- CCM certification preferred.
- Strong clinical communication, documentation, technology, and multidisciplinary collaboration skills; empathy and sound prioritization are essential.
- Able and willing to work until 6pm PST and comply with security and HIPAA requirements.
✨ Benefits
- Equity
- 401(k) savings plan
- Medical coverage
- Vision coverage
- Dental coverage
- Disability insurance
- Paid time off and discretionary time off
- 12 weeks of 100% paid parental leave
Full job description
We’re looking for a Newborn/Pediatric Nurse Care Manager for our Care and Case Management team, who is passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading interventions.
The telephonic Nurse Care Manager will guide members through complex medical and behavioral Health situations, partnering with a multidisciplinary clinical team that includes a variety of healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care in an innovative way. The Nurse Care Manager should enjoy spending time on the phone, listening to members’ needs, answering questions, and serving as an advocate. They should also excel at creating cohesive care plans, and should possess the clinical acumen to guide members clinically and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes.
Responsibilities:
Deliver coordinated, patient-centered virtual Care Management by telephone and/or video that improves members’ health outcomes.
Generate impactful care plans together with members and our multidisciplinary care team, and help members achieve the desired goals.
Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
Partner with the members’ local providers to ensure coordinated care.
Provide compassionate, longitudinal follow-up care, building supportive relationships.
Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
Coordinate necessary resources that holistically address members’ problems, whether clinical or social
Required Qualifications:
Must reside in a compact NLC state.
Active Compact RN license (in state of residence) in good standing with the nursing board of their state
Active, unrestricted California RN license preferred
Willingness to obtain and maintain licensure in multiple states.
CCM (Certified Case Manager) Certification preferred.
Minimum of 5 years of nursing experience.
2+ years experience working in Pediatric setting
2+ years experience working in care, case and disease management, preferably in a health plan, health navigator or third party administrator (TPA) environment
Be able and willing to work until 6pm PST
Be comfortable discussing a wide variety of medical conditions
Experience working remotely preferred; Comfortable with technology.
Be highly empathetic. We work with patients and their families who are going through challenging times. Ideal candidates practice empathy and reassure patients that we are available to help them.
Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet volume goals without sacrificing quality. Good judgment for balancing priorities is a must.
Be flexible and comfortable with working in a rapidly-changing environment.
Strictly follow security and HIPAA regulations to protect our patients’ medical information.
Be pleasant, responsive, and willing to work with and learn from our team.
Strong verbal and written communication skills. A lot of time is spent on the phone with patients and families, as well as a lot of time communicating with colleagues. Therefore, the ability to gather a clinical history, answer questions at a patient level, and succinctly summarize findings is critical.
Strong competence and ability to use multiple computer/medical record systems.
Collaborate well across multidisciplinary teams with clinical and non-clinical members to deliver a seamless, top-quality care experience to patients.
Ability to understand cultural and socioeconomic issues affecting members and to coordinate all available resources to serve members.
Excellent grammar, attention to detail, and efficient at writing medical information in easy-to-understand, patient-centric language.
Similar jobs
Search more Clinical Operations Specialist jobs
🕒 yesterday
Prepare and submit healthcare insurance authorization requests, organize supporting documentation, navigate payer portals, and track submissions while resolving routine issues accurately and independently.
🕒 2 days ago
Process high-volume oncology prior authorizations while supporting other assistants, coordinating with providers and payors, and helping improve workflows as they integrate AI-powered automation.
🕒 2 days ago
Process high-volume cardiology prior authorizations, support other assistants, and help improve workflows as they integrate with AI-powered tools and healthcare technology.
🕒 2 days ago
Reviews prior authorization requests for medical necessity using evidence-based clinical guidelines, documents determinations, and refers cases that do not meet criteria to physician reviewers.