This role coordinates pediatric medical and behavioral care across the continuum of care. The Care Manager is assigned to specific product lines (e.g., PHSP, Child Health Plus, FIDA, CompleteCare, SNP, Medicaid/Medicare, HARP, etc.) and applies care‑management principles when engaging members and coordinating health‑care services.
This is a 100% remote position.
Responsibilities
Plan and manage pediatric medical and behavioral care for members and their beneficiaries.
Apply care‑management principles when engaging members and health‑care team members, coordinating health‑care services.
Adhere to standards of care for children, including developmentally disabled, medically fragile, and foster care populations.
Develop a member‑centric plan of care through collaboration with the member (as age appropriate), family, appointed guardian, and the multidisciplinary health‑care team (pediatricians, specialists, health homes, school/facility social workers, and community‑based service providers).
Document all encounters with pediatric members, guardians, legal representatives, providers, and vendors in the appropriate system; follow up as needed and update plans of care based on member needs and goals.
Identify opportunities for alternative care options based on member needs and assessments and coordinate referrals to aid in goal achievement.
Minimum Qualifications
Conduct assessments telephonically to identify barriers and opportunities for intervention.
Evaluate service authorizations and advocate to ensure alignment and execution of the member’s care and physician treatment plan.
Educate beneficiaries on available health‑care services within their coverage plan, empowering self‑management.
Possess a New York State RN, LCSW, or LMSW license.
Have at least 1 year of pediatric clinical experience with families and child‑serving systems, including child welfare and/or medically fragile/developmentally disabled populations.
Proficient in navigating multiple electronic documentation systems.
Show strong collaboration skills with multiple stakeholders to secure appropriate care.
Exhibit strong interpersonal and assessment skills, especially in rapidly changing crisis situations involving children, families, and community care providers.
Preferred Qualifications
Knowledge of current community health practices for medically and/or emotionally fragile pediatric populations.
Bilingual in Spanish.
Experience managing member information in a shared network environment using paperless database modules and archival systems.
Relevant work experience as a Care Manager.
Demonstrated ability to manage large caseloads and work effectively in a fast‑paced environment.
Hiring Range
Greater New York City Area (NY, NJ, CT residents): $81,099 – $116,480
All other locations (within approved locations): $71,594 – $106,080
Benefits
Healthfirst offers a full range of benefits, including medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401(k) contributions (subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever employees work and live.