Pediatric RN Case Manager

Job Description: Pediatric Case Manager in DC.

Position Title: Pediatric Case Manager
Location: DC
Employment Type: Full-time, Contract.
Shift: 5x8 Days, 8:30 AM - 5:00 PM

Overview

We are seeking an experienced Pediatric Case Manager to join our healthcare team. The ideal candidate will have 5 years of case management experience, with 2 years in pediatric case management preferred. As a Pediatric Case Manager, you will play a vital role in coordinating care for pediatric patients, ensuring the best possible outcomes by providing effective discharge planning, working closely with community resources, and supporting the delivery of patient-centered care.

Key Responsibilities:

• Care Coordination: Coordinate and manage the care of pediatric patients, ensuring they receive appropriate treatments and services across multiple care settings.
• Discharge Planning: Develop and implement discharge plans for pediatric patients, collaborating with family members, vendors, and agencies to ensure a smooth transition from the hospital to home or other care facilities.
• Collaboration: Work closely with healthcare providers, community agencies, private duty nursing, and vendors to ensure continuity of care for patients post-discharge.
• Utilization Review: Assess and ensure that patients meet the necessary criteria for continued care through Utilization Review and by applying Milliman Guidelines (MCG) for medical necessity.
• Concurrent Review: Review patient cases in real-time to ensure the appropriate level of care is provided and that care is medically necessary.
• Admission Criteria: Apply admission criteria to determine the appropriateness of patient admission based on their medical needs.
• Patient Diagnosis: Manage and oversee care for a variety of pediatric diagnoses, including but not limited to:
• Prematurity
• Bronchopulmonary Dysplasia (BPD)
• Cerebral Palsy (CP)
• Seizure Disorders
• Post-Surgical (S/P)
• Motor Vehicle Accidents (MVA)
• Trauma and Post-Trauma Care
• Documentation: Maintain accurate and timely documentation of patient assessments, care plans, and all case management activities in compliance with hospital and regulatory standards.

Qualifications:

• Education:
• Bachelor of Science in Nursing (BSN) required
• Certifications:
• Basic Life Support (BLS) certification required
• Experience:
• Minimum of 5 years of case management experience
• 2 years of pediatric case management experience preferred
• Skills & Knowledge:
• Knowledge and experience with Milliman Care Guidelines (MCG) and medical necessity criteria
• Strong background in discharge planning, utilization review, and care coordination
• Ability to work effectively with community vendors, agencies, and private duty nursing
• Excellent communication and collaboration skills with interdisciplinary teams

Preferred Skills:

• Previous experience working with pediatric patients and complex medical conditions
• Familiarity with hospital systems, discharge planning tools, and electronic health records (EHR)
• Strong problem-solving skills and attention to detail

Job Types: Full-time, Contract

Pay: $57.00 - $75.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Health insurance

Schedule:

• 8 hour shift
• Day shift
• Weekends only

License/Certification:

• Certified Case Manager (Preferred)

Ability to Commute:

• Washington, DC 20002 (Required)

Ability to Relocate:

• Washington, DC 20002: Relocate before starting work (Preferred)

Work Location: In person