Medical Case Manager - Pediatrics - SUNSHINE ENTERPRISE USA LLC

 

Medical Case Manager - Pediatrics

Company Overview: Our client is a leading healthcare located in Orange, CA, seeking a medical case manager, who will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes for all members along with focus on members under 21 years of age.

Position Summary: The successful candidate should hold a current, unrestricted registered nurse (RN) license to practice in the state of California, holds a bachelor’s degree in nursing, and has 3 years of clinical experience dealing with pediatric patients.

 

Work Duration: Up to 6 months

Work hours: 8 am – 5 pm, M-F

 

Position Responsibilities:

• Assesses member needs using a standardized health needs assessment or health risk assessment.
  
• Conduct post-discharge assessments to identify and address member needs, including physical, functional, social, and psychological aspects, as well as cultural, linguistic, and caregiver support.
  
• Develop and implement personalized care plans with SMART goals, updating them regularly based on the member’s condition and progress.
  
• Schedule follow-ups to monitor progress, identify obstacles, and ensure quality of care according to department standards.
  
• Coordinate with members, families, providers, and community resources to align care and services, including referrals to behavioral health and LTSS as needed.
  
• Communicate with physicians, specialists, and other agencies to ensure seamless care coordination.
  
• Facilitate and participate in interdisciplinary meetings, collaborating with internal teams for case resolution.
  

 Identify cases requiring further review, routing them to the appropriate authority and closing them in accordance with procedures.

• Advocate for members’ best interests in securing necessary resources, treatment options, and timely care adjustments.
  
• Complete additional assignments and projects as assigned.
  

 

Experience & Education:

·       Current, unrestricted RN license to practice in the state of California required.

·       Bachelor’s degree in nursing (BSN) required

·       3 years of clinical experience and/or managed care experience required

·       2 years of pediatric experience highly preferred

·       Active Commission for Case Manager (CCM) certification preferred

Necessary Attributes:

• Establish effective relationships with internal and external stakeholders.
  
• Demonstrate independent judgment and decision-making skills.
  
• Communicate effectively both verbally and in writing.
  
• Flexible schedule availability for evening and weekend events.
  
• Strong organizational, analytical, and problem-solving abilities.
  
• Proficiency in Microsoft Office (Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.
  

 

Please see HR for information on physical demands and work environment of this job.

 

Sunshine Enterprise USA is an “Equal Opportunity Employer—Minorities, Females, Veterans and Disabled Persons”

 

• Bachelor’s degree PLUS 2 years of experience in facilities management or property management required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. • 2 years of experience as an administrative assistant.