Position Summary

Key Responsibilities

Care Coordination & Case Management

• Conduct comprehensive assessments of pediatric patients to identify medical, behavioral, educational, and psychosocial needs.
• Develop, implement, and continuously evaluate individualized transition care plans in collaboration with families, physicians, school personnel, and ancillary providers.
• Coordinate transitions from inpatient hospital settings to home, outpatient, rehabilitative, school-based, or specialty pediatric care.
• Monitor patient progress, adjust care plans as clinical needs evolve, and document all encounters in compliance with HIPAA and agency standards.

Referral & Relationship Management

• Leverage and expand an existing referral base across New Jersey hospitals, pediatric medical practices, specialty providers, and school districts.
• Build and maintain trusted relationships with discharge planners, social workers, pediatricians, school nurses, IEP/504 teams, and child study teams.
• Represent the organization at community events, school meetings, hospital rounds, and provider in-services to grow visibility and referral volume.
• Track referral sources, conversion rates, and outcomes; report regularly to leadership.

Family & Patient Advocacy

• Educate families on diagnoses, treatment plans, available services, and insurance/benefit navigation (Medicaid, NJ FamilyCare, private insurance).
• Advocate for patient access to appropriate medical, therapeutic, behavioral health, and educational supports.
• Provide culturally competent, family-centered care to a diverse pediatric population.

Compliance & Quality

• Ensure all care management activities comply with NJ state regulations, payer requirements, and agency policies.
• Maintain accurate, timely documentation in the electronic health record or care management system.
• Participate in interdisciplinary case reviews, quality improvement initiatives, and continuing education.

Required Qualifications

• Active New Jersey RN, LSW, LCSW, or related clinical license in good standing.
• Minimum 3 years of pediatric care management, case management, or transition-of-care experience in New Jersey.
• Established and active referral relationships with NJ hospitals, pediatric practices, and/or school systems.
• Working knowledge of NJ Medicaid, NJ FamilyCare, EPSDT, IEP/504 processes, and pediatric specialty care networks.
• Strong clinical assessment, documentation, and care planning skills.
• Excellent communication, organization, and relationship-building abilities.
• Valid NJ driver's license, reliable transportation, and willingness to travel within assigned territory.
• Proficiency with electronic health records and care management software.

Preferred Qualifications

• Bachelor's or Master's degree in Nursing, Social Work, Public Health, or related field.
• CCM (Certified Case Manager) or equivalent certification.
• Bilingual English/Spanish.
• Prior experience with medically complex children, behavioral health, or special education populations.

Compensation & Benefits

• Competitive salary commensurate with experience. (Salary starting at $150,000+, plus commission. Potential signing bonus.)
• Performance-based bonus tied to referral growth and patient outcomes.
• Medical, dental, and vision insurance.
• 401(k) with employer match.
• Paid time off, holidays, and CEU/licensure reimbursement.
• Mileage reimbursement and flexible/hybrid schedule.