Pennsylvania Licensed Pediatric Care Manager
Job Summary
To support pediatric care management, the full-time Pennsylvania Licensed Pediatric Care Manager will conduct utilization reviews, assess member care barriers, and facilitate safe discharges from inpatient settings while working remotely during standard business hours.
Key responsibilities
- Obtain and document necessary information to support requested levels of care and notify providers of health plan determinations
- Review clinical information and conduct authorization requests using established criteria for various care types
- Collaborate with interdisciplinary teams to discuss complex cases and ensure appropriate discharge plans are in place
Required qualifications
- Minimum of 2 years of clinical and/or case management nursing experience
- At least 1 year of experience in Utilization Management
- Pediatric experience strongly preferred
- Active Pennsylvania RN license or multistate license preferred
- BSN and experience with Epic are bonuses
Complete Job Description
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