Medical Case Manager (Pediatrics)

TL;DR

Medical Case Manager (Pediatrics): Coordinating high-quality, cost-effective healthcare for members with complex medical and psychosocial needs with an accent on holistic assessment and care planning. Focus on managing transitions of care, collaborating with interdisciplinary teams, and advocating for appropriate care plans.

Location: Must be based in Delaware (Working at Home with frequent visits to Nemours Hospital in New Castle County)

Company

hirify.global is a healthcare provider and insurer focused on ensuring members have access to high-quality, cost-effective health care.

What you will do

• Perform holistic assessments and develop individualized care plans for members with complex medical and psychosocial needs.
• Coordinate care between Primary Care Physicians, medical specialists, and home health providers.
• Conduct telephonic interviewing and collaborate with Physician Advisors and internal departmental contacts.
• Educate members on illness impact and pharmacy regimen maintenance to improve health outcomes.
• Facilitate interdisciplinary and interagency meetings to coordinate necessary services and resources.
• Monitor member progress toward goals and re-adjust care plans as indicated.

Requirements

• Bachelor’s degree in Nursing (or RN certification) or Master’s degree in Social Work, Counseling, or Education.
• 3-5 years of experience in Acute or Managed Care, specifically with Medicaid or Medicare populations.
• Valid licensure as an RN or a licensed Social Worker (LSW, LCSW, LBSW, etc.) or Professional Counselor (LPC).
• Must be based in Delaware to facilitate frequent visits to Nemours Hospital.

Nice to have

• Experience working with pediatrics, high-risk pregnant women, or chronic condition adult populations.
• Bilingual skills in English and Spanish.
• Case Management Certification.

Culture & Benefits

• Hybrid work environment offering a "Working at Home" arrangement within Delaware.
• Collaborative team environment involving interdisciplinary coordination.
• Access to annual internal and external continuing education forums to maintain professional licensure.
• Strict adherence to ethical and legal standards and behavioral expectations.