RN Case Manager - Child Services

The RN Case Manager here will be performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs.

Major Job Duties:

• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.

• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.

• Coordinates internal and external resources to meet identified needs.

• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

• Interfaces with Medical Directors and Physician Adviso rs on the development of care management treatment plans.

• Negotiates rates of reimbursement, as applicable.

• Assists in problem solving with providers, claims or service issues.

• Assists with development of utilization/care management policies and procedures.

What We Look For:

• Must have clear and active RN license in the state of NJ

• Must have minimum 3 years of pediatric experience in hospital or home care setting

• Requires knowledge of health insurance/benefits

• Requires knowledge of care management/case management assessment techniques (case management)

• Strong oral, written, and interpersonal communication

• Proficiency with computers

Are you a Registered Nurse in Naples area looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a Fortune 500 company that provides on-going training and development? Are you interested in working for a company that offers benefits for full-time permanent employees, flex schedules and the opportunity to grow with the company? If you answered “yes” to any of these questions – this is the position for you!

Interested in learning more, contact Christina Turley at 407-478-0332 ext 138 and send your resume to

The greatest compliment to our business is a referral. If you know of someone looking for a new opportunity, please pass along my contact information!