This role requires travel within Kent and/or Sussex counties in DE. Delaware residency is preferred and Delaware licensure is required.
Your career starts now. We are looking for the next generation of healthcare leaders.
At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear from you.
Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Summary:
The Care Manager II (RN/LSW) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management.
Responsibilities:
- Provide transitional care management. (Includes but not limited to completing visits in assigned inpatient facilities as well as participating in discharge planning with members)
- Meet regularly with designated partners regarding Plan-identified Members for care management, assist with reducing/resolving problems and/or barriers so the ACDE Care Coordinator may provide members with high-quality care management services.
- Engage the Member, the Member's caregiver(s), and Providers to assess plan and establish individual Member goals
- Will facilitate and coordinate care for the Members while ensuring quality and use of cost-effective resources
- Function as a single point-of-contact; be an advocate for Members in the care coordination program
- Oversee these same care management activities within assigned practices to ensure AmeriHealth Caritas Delaware (ACDE) delivers high-quality care management services in accordance with Plan, NCQA, Federal/State standards and requirements
- Assess Members through face-to-face encounter and by telephone to determine care coordination and care management needs for all referred Members
- Complete comprehensive person-centered assessment inclusive of physical health history, mental health history, social determinants of health, and supportive needs
- Coordinate physical, behavioral health, and social services
- Provide medication management, including regular medication reconciliation and support of medication adherence
- Identify problems/barriers for care coordination and appropriate care management interventions
- Create a plan of care to assist members in reducing/resolving problems and/or barriers so that Members may achieve their optimal level of health
- Identify goals and assign priority with associated time frames for completion; share goals with the Member and family as appropriate
- Identify and implement the appropriate level of intervention based upon the Member’s needs and clinical progress
- Schedule follow-up calls as necessary, make appropriate referrals, implement actions to address Member issues, and document progress toward meeting goals and resolving problems
- Coordinate care and services with the Community Health Navigator, Member, Member's caregiver(s) as appropriate, PCP, Specialist, and Facility/Vendor Providers.
- Participate in regularly scheduled meetings as needed
Education/Experience:
- Current and unrestricted RN licensure in Delaware required, and/or current and unrestricted LBSW, LMSW, or LCSW in Delaware and three (3) years of professional practice experience
- Minimum three (3) years’ experience as a Case Manager required, preferably providing telephonic case management
- Minimum one (1) year experience in transitional care and discharge planning preferred
- Proficiency using MS Office (Word, Excel, Outlook), Internet applications, and electronic medical record and documentation programs
- Ability to meet deliverables within designated timeframes
- Strong organization and communication (listening, verbal and written) skills
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Competitive pay, Paid Time Off (PTO) including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more.
