Job Description

Job Brief

Must reside in PA. Current and unrestricted PA RN license. 3+ years of clinical exp w medically fragile pediatric patients in an acute care, home care, or special needs clinic. Case management experience desired.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care 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 you.

Headquartered in Newtown Square, PA, 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.

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Responsibilities:

The Care Manager II assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager II is responsible for engaging the member, member care giver and providers to assess plan and establish individual member goals. Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources. The position will function as a single point of contact and be an advocate for members in the care management program. 

• Telephonically assesses members to determine care coordination and care management needs.
• Completes comprehensive person centered assessment inclusive of physical health history, mental health history, social determinants of health and supportive needs. 
• Coordinates physical, behavioral health and social services;
• Provides medication management, including regular medication reconciliation and support of medication adherence;
• Identifies problems/barriers for care coordination and appropriate care management interventions.
• Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health. 
• Identifies goals and assigns priority with associated time frames for completion. Shares goals with the member and family as appropriate.
• Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress.
• Schedules follow up calls as necessary, makes appropriate referrals. Implements actions to address member issues. Documents progress towards meeting goals and resolving problems. 
• Coordinates care and services with the Care Coordinator, Community Health Navigator, and member, member care giver as appropriate, PCP, Specialist, and Facility/Vendor Providers.

Education/Experience:

• Must reside in Pennsylvania.
• Bachelor's Degree in Nursing or health related field.
• Current and unrestricted Registered Nurse licensure in Pennsylvania. 
• 3+ years of clinical experience at the bedside (as a Registered Nurse) working with medically fragile pediatric patients in an acute care, home care, or special needs clinic.
• 3+ years of Case Management experience, preferably telephonic within a managed care organization, desired. 
• Eligible to sit for Case Management certification after 12 months of employment. Must obtain this certification after 1 year of employment.
• Demonstrated proficiency working within a Windows 11 environment to include MS Office (Excel, Word, Outlook) and electronic medical record and documentation programs.
• Valid driver's license and car insurance. Must be willing to drive a personal vehicle for work related events/meetings.
• Ability to work Monday-Friday from 8:30a to 5:00p EST. 

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

Flexible work solutions including remote options, hybrid work schedules, competitive pay, paid time off including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1 of employment, 401(k), tuition reimbursement and more.

#PH #HM

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