PDN Registered Nurse Case Manager
About The Position
Sunshine Pediatric Day Center is a Prescribed Pediatric Extended Care (PPEC) facility delivering an innovative model of medical day care to medically complex and technology-dependent children. Our team of nurses, therapists, and child-care professionals provides skilled nursing care in a warm, engaging, family-centered environment — giving kids a place to thrive during the day and giving caregivers the support they deserve. We are seeking a Registered Nurse Case Manager with PDN experience to serve as the clinical quarterback for each child enrolled in our PDN program. This role owns the full lifecycle of patient care coordination — from referral and intake through ongoing plan-of-care management, family education, physician communication, payer authorization, and continuity across home, school, and outside providers. If you love the relationship-building side of pediatric nursing, are highly organized, and want a role where you advocate for kids and families while keeping clinical operations running smoothly — this is it.
Requirements
- Active, unrestricted Registered Nurse (RN) license in the state of practice
- Current BLS/CPR certification (AHA preferred)
- Minimum 2–3 years of pediatric nursing experience (PPEC, pediatric home health, pediatric skilled nursing, PICU, NICU, or pediatric long-term care)
- Working knowledge of medically complex, technology-dependent pediatric care (trach, vent, G-tube, centrallines, seizure precautions, oxygen therapy)
- Strong understanding of pediatric plans of care, physician orders, and care coordination
- Excellent written and verbal communication skills
- Proficiency with EHR systems and Microsoft Office / Google Workspace
Nice To Haves
- PALS preferred
- BSN
- Prior case management, care coordination, or utilization review experience
- Experience working with Medicaid, Medicaid MCOs (STAR Kids, STAR), and private insurance for pediatric authorizations
- Familiarity with PPEC, pediatric medical day care, or pediatric skilled nursing regulations
- Bilingual (English/Spanish) a plus
- Case Management Certification (CCM, ACM, or RN-BC) a plus
Responsibilities
- Serve as the primary clinical point of contact for incoming referrals from hospitals, physicians, discharge planners, MCOs, and community partners
- Review referrals for clinical appropriateness and PPEC admission criteria
- Conduct or coordinate initial nursing assessments, gather medical records, and verify physician orders
- Partner with the Administrator and Director of Nursing on admission decisions and onboarding logistics
- Develop, implement, and continuously update individualized plans of care for each enrolled child
- Ensure plans of care reflect current physician orders, diagnoses, equipment needs, medication regimens, therapy goals, and family preferences
- Conduct regular case reviews and reassessments at required intervals
- Coordinate with the medical director, PCPs, specialists, and therapists to keep care plans aligned and current
- Act as the clinical liaison between families, physicians, therapists, home health agencies, schools, programs, hospitals, and equipment vendors
- Coordinate transitions of care (hospital admissions/discharges, ER visits, specialist appointments, new diagnoses)
- Track upcoming appointments, immunizations, screenings, and follow-up needs
- Support families with navigating the healthcare system, accessing community resources, and understanding their child's care
- Obtain and maintain insurance authorizations and reauthorizations (Medicaid, MCOs, private payers); submit clinical documentation to support medical necessity
- Maintain accurate, timely, and HIPAA-compliant documentation in the EHR
- Ensure case files meet state, federal, and payer regulatory requirements
- Participate in chart audits, survey readiness, and quality improvement initiatives
- Build trusting, long-term relationships with families as their consistent point of clinical contact
- Educate caregivers on diagnoses, equipment, medications, and care plan goals
- Resolve concerns and escalations with empathy and professionalism
- Advocate for the child and family across the care continuum
- Partner with bedside RNs, LPNs, therapists, and clinical leadership to ensure consistent execution of each child's plan of care
- Communicate plan-of-care changes promptly to the clinical team
- Contribute to interdisciplinary care conferences and team huddles
- Support clinical leadership with census growth, retention, and program development
Benefits
- Competitive pay commensurate with experience
- Medical, dental, and vision insurance
- 401(k) participation
- Paid time off and paid holidays
- Paid CEUs and professional development
- Low patient ratios, relationship-based care, and a mission-driven culture
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
