Pediatric Care Manager, Social Work

Company: Sunshine State Health Plan
Location: Miami
Posted on: November 18, 2023

Job Description:

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.


This is a remote/work-from-home position where member visits are required. Candidates must reside in the Miami-Dade County region to be considered for this role.

Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.

Develop, assess and adjust, as necessary, the care plan and promote desired outcome
Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
Provide patient and provider education
Facilitate member access to community based services
Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems

Education/Experience: Bachelor's degree in Social Work. 2+ years of social work experience in an acute care or community setting. Knowledge of government sponsored managed care programs preferred.

Licenses/Certifications: Current state's LMSW or LCSW license.

For Sunshine Health (FL): An RN, LCSW, LMSW, LMHC or other Mental Health Professional license is required. Employees supporting Florida's Children's Medical Services (CMS) must have one of the above professional licenses and 1. Minimum of two years of pediatric experience for Florida licensed registered nurses, or 2. Hold a Master's degree in social work or related field and have one year of related professional pediatric care experience. May require up to 80% local travel.

Additional Details:

Licensure requirement: Master's degree in Social Work and LCSW, LMSW, LMHC


Experience: 1 year (minimum) pediatric experience


Location: Residency required in Miami-Dade County


Travel: 80% local travel




Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.


Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Sunshine State Health Plan, Miami , Pediatric Care Manager, Social Work, Executive , Miami, Florida