Pediatric - Complex Care Manager

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It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary

This position will act as the key medical care manager for pediatric patients with medical and psychosocial complexity. The Complex Care Manager works with relevant stakeholders to engage patients in care management with a focus on patient experience and improving health. This role will be part of an interdisciplinary team serving culturally diverse families with chronic illnesses, special needs, and a variety of neurodevelopmental and related diagnoses. The individual is responsible for outreach to families, meeting with families during clinic sessions, and making home visits in the community. Using the information gathered from the family and the medical team, the care manager is responsible for developing and implementing an individualized, patient-centered care plan. Implementation of the care plan may involve: working with partnering organizations to ensure the child is receiving necessary services, assisting families in interactions with school system and community agencies, and acting as a liaison with the child’s insurance plan. Excellent interpersonal skills, clinical expertise in pediatrics and the ability to work both independently and collaboratively are key requirements of the job.

Our Investment In You

• Full-time remote work
• Competitive salaries
• Excellent benefits
  
  

Key Functions/Responsibilities

• Ability to execute core care management duties:
• Comprehensive assessment: bio-psycho-social-spiritual
• Collaboration with patient and care team to develop patient-centered care plan, with particular focus on chronic disease management, social determinants, transitions of care and advanced care planning.
• Collaboration with program stakeholders and community partners.
• Coordinates with health care providers to make sure needs are being met.
• S/he will also work with partnering organizations to make sure that children have all needed medical services
• The individual is responsible for working with patients to identify strengths and barriers and to develop an individualized, patient-centered care plan. Excellent interpersonal skills, clinical expertise in pediatrics and the ability to work both independently and collaboratively are key requirements of the job
• Has knowledge of common chronic medical conditions presented in the population served and is able to:
• Educate the patient and their caregivers on their conditions and medications, and build their self-management skills;
• Use motivational interviewing to promote behavioral change;
• Assess, triage, and rapidly respond to clinical changes that could lead to the need for emergency services if not intervened upon.
• Meets regularly with team members and care management supervisor to triage program issues appropriately.
• Actively participates in planning and growth of program with relevant stakeholders as needed
• Facilitates interdisciplinary consultation on patient’s behalf through participation in clinical review team (CRT) meetings
• The individual will arrange for case conferences as needed, involving school, day care and early intervention services providers as appropriate.
• Complies with established metrics for performance and adheres to documentation and work flow standards
• Maintains HIPAA standards and confidentiality of protected health information.
• Follows established infection control and safety procedures.
• Adheres to departmental/organizational policies and procedures.
• Care Manager will work full-time from their home and visit patients in the community
• Other duties as assigned
  
  

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

Education

Job Requirements:

• BS Nursing
  
  

Certificates, Licenses & Registrations Required

• Licensed to practice professional nursing as a Registered Nurse in the Commonwealth of Massachusetts.
• Transportation
  
  

Experience

• A minimum of 2-5 years of pediatric clinical experience is preferred.
• Direct care experience in a pediatric outpatient, community or multidisciplinary setting preferred.
  
  

Preferred Experience

• Experience working with vulnerable patient populations
• Home care or clinic
• Motivational interviewing
• Clinical experience working with patients with multiple complex needs
• Ability to adapt to changes in healthcare delivery at local and systems level
• Extensive knowledge of healthcare systems and community resources
• Ability to leverage systems and resources for improved patient outcomes
• Strong organizational and time management skills
• Access to personal transportation required
• Digital literacy required
• Fluency in a second language is a plus
  
  

Knowledge & Skills

• Excellent interpersonal skills and ability to work collaboratively
• Self-management skills, including ability to prioritize and set patient-centered goals
• Excellent written and verbal communication
• Able to maintain professional boundaries
• Ability to work with diverse, safety-net population
• Creative problem solver
  
  

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

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