Medical Case Manager (Pediatric)

TL;DR

Medical Case Manager (Pediatric): Facilitating high-quality, cost-effective healthcare for members with complex medical needs with an accent on holistic assessment, care planning, and interdisciplinary coordination. Focus on managing pediatric cases, ensuring adherence to care plans, and collaborating with healthcare providers to improve patient outcomes.

Location: Must be based in Kent County, Delaware. This is a hybrid role requiring frequent travel within the assigned territory in DE and home visits.

Company

hirify.global is a national health and wellness organization providing comprehensive healthcare services and insurance solutions.

What you will do

• Conduct holistic assessments and develop individualized care plans for members with complex medical or psychosocial needs.
• Coordinate care by collaborating with primary care physicians, specialists, and home health providers.
• Monitor member progress toward goals and adjust care plans as necessary to ensure effective outcomes.
• Facilitate interdisciplinary team meetings to align resources and services for members.
• Educate members and their families on disease management, pharmacy regimens, and care plan adherence.
• Maintain accurate documentation in compliance with regulatory guidelines and HIPAA standards.

Requirements

• Bachelor’s degree in nursing or RN certification, or a Master’s degree in Social Work, Counseling, or Education.
• Minimum 3 years of experience in Acute or Managed Care, specifically with Medicaid or Medicare populations.
• Current state RN licensure or multi-state licensure through the eNLC, or relevant Social Work/Counseling licensure (LSW, LPC, LCSW, etc.).
• Ability to work independently and manage a caseload within the assigned territory.
• Strong communication skills for telephonic interviewing and interdepartmental collaboration.
• Must be based in or able to work within Kent County, Delaware.

Nice to have

• Experience with pediatric populations.
• Experience working with high-risk pregnant women or chronic adult conditions.
• Bilingual English/Spanish language skills.
• Case Management Certification.

Culture & Benefits

• Opportunity to work in a mission-driven environment focused on improving patient health outcomes.
• Collaborative team environment with regular interdisciplinary rounds and professional development.
• Commitment to ethical standards and data security compliance.
• Support for continuing education to maintain professional licensure and clinical skills.