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Pediatric Case Management Nurse Coordinator - No Nights or Weekends!

Company: CenCal Health
Location: Santa Barbara
Posted on: December 2, 2018

Job Description:

Location: Santa Barbara, California, 93101, United StatesJob ID: 45102838Posted: 11/20/2018Position Title: Pediatric Case Management Nurse Coordinator - No Nights or Weekends!Company Name: CenCal HealthSector: HospitalEntry Level: falseJob Type: Full-TimePediatric Case Management Nurse Coordinator Shift: Monday-Friday 8:00-5:00Classification: ExemptDepartment: Health ServicesLooking for a career that makes a difference in people's lives? CenCal Health is a locally-run, not-for-profit health plan that serves nearly 180,000 people, with offices in both Santa Barbara and San Luis Obispo Counties. For 35 years, we've been improving the health and well-being of our neighbors through partnership and collaboration, and we're looking for exceptional, mission-driven professionals to help us grow. We are an employer of choice in Santa Barbara, offering competitive salaries, generous vacation & holidays, comprehensive health/dental/vision benefits including a CalPERS pension plan and 457 deferred income plan, a wellness program, a gym in our headquarters and parking lot BBQs. Come join our group of nice people doing good work at a great company.Job SummaryThe CenCal Health Pediatric CM Nurse Coordinator is a blended role that incorporates the responsibilities of case management and utilization management activities. Case Management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates services required to meet the member's health care needs and to the extent possible, address their social needs. CM activities include advocacy, coordination, communication, resource management, and the promotion of quality and cost-effective interventions and outcomes/goals. UM activities include reviewing prospective and retrospective requests for authorization and referrals, performing concurrent inpatient review, coordinating inpatient transfers and care transitions activities. The Pediatric CM Nurse Coordinator assist specific members under the age of 21, who qualify for the Pediatric Whole-Child Program with care coordination, which include processing medically necessary service requests, facilitating care transitions, and communicating with members and providers to assure the medical needs of the member are met. The Pedi CM Nurse Coordinator will assist members and their families by optimizing their wellness level and improve or maintain their functional capabilities by empowering them with education and self-managing tools, and assisting with care coordination or care transition.Duties and ResponsibilitiesThis position is responsible for coordinating and managing specific CenCal Health members for defined periods of time and/or post discharge transition from an inpatient setting (e.g. acute care hospital, skilled or long-term care facility) to ensure that member's outpatient care is being coordinated and that all medically necessary services are being provided in a timely manner. In addition, this position requires the management of complex care members over longer periods as deemed appropriate, and potentially preventable admissions.Responsibilities include but are not limited to:


  • Coordinate the provision of quality and cost-effective health care services
  • Coordinate care and services for members and effectively and efficiently implement and complete the care management process. This process involves health screening, assessment, care planning, coordination of care, and monitoring of member's progress and compliance
  • Collaboratively develop realistic individualized care plan with member and their family
  • Perform concurrent review of hospitalized member
  • Assist with discharge planning and care transitions from one care setting to another
  • Process service requests and specialty referrals in a timely manner
  • Collaborate with the member, the member's family or caretaker, primary care provider, and other health care providers
  • Coordinate timely care transition from one level of care to another, such acute to SNF or SNF to home or other living arrangement as the member's care needs change
  • Effectively communicate and educate members about the health care delivery system and health plan benefits and limitations
  • Identify care needs of the member, identify interventions, develop plan of care, implement necessary services, and establish timelines for case management services
  • Effectively communicate verbally and in writing with primary care providers and other health care providers involved in the member's care
  • Adhere to Health Plan and department specific policies and procedures
  • Collaborate with contracted agencies and community based organizations to provide supportive services when needed (VNA- home nursing, PT, Meals on Wheels etc.)
  • Support and collaborate with the management and health services team members in the implementation and management of CM activities
  • Actively participate in the development, implementation and evaluation of department initiatives with the intent to assess and evaluate any measurable improvements to member's quality of care
  • Other duties as assigned

    Education and Experience

    • Current active, unrestricted California Registered Nurse License with a minimum two (2) years' experience as a Registered Nurse in an inpatient, outpatient, or office setting.
    • Proficient with computer and Microsoft Office, Word, Excel, PowerPoint
    • Strong organizational skills and excellent verbal and written communication skills
    • Desired: A minimum of one (1) year clinical experience working with the pediatric population
    • Desired: Certification in case management, utilization review, or healthcare management
    • Desired: Prior UM/CM experience in a managed care setting

      The above information on this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.PI105799478

      Keywords: CenCal Health, Santa Barbara , Pediatric Case Management Nurse Coordinator - No Nights or Weekends!, Healthcare , Santa Barbara, California

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