Care Manager

IntelliResume; Pennsylvania; Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Remote options

Hybrid work schedules

Competitive pay

Health insurance

Job summary

AmeriHealth Caritas is seeking a Care Manager II (RN/SW) to assist members with care management and coordination services to achieve optimal health through self‑management. This role collaborates with families and providers to set and reach individual health goals.

Location: Philadelphia, PA. Schedule: Full-time, Monday–Friday 8:30am‑5:00pm ET. Responsibilities include assessments, cross‑disciplinary coordination, and EMR documentation to ensure coordinated care.

Qualifications

• Current, unrestricted RN license in good standing or unrestricted LMSW/LCSW license.
• 3–5 years experience with the physical health population.
• Experience with Medicaid/Medicare populations preferred.
• Case management experience within a managed care organization is desirable.

Responsibilities

• Assess members through face‑to‑face encounters and by telephone to determine care coordination needs.
• Complete comprehensive person‑centered assessments including health histories and social determinants.
• Coordinate physical, behavioral health, and social services.
• Provide medication management including reconciliation and adherence support.
• Identify barriers and create plans of care to reach optimal health.
• Schedule follow‑ups and make appropriate referrals; document progress in the EMR.
• Coordinate care with caregivers, PCPs, specialists, and facility/providers; participate in meetings as needed.
• Deliver transitional care management as required.

Education

RN license

LMSW/LCSW license

Job description

About This Role

The Care Manager II (RN/SW) plays a crucial role in assisting members with care management and coordination services to achieve optimal health through self-management. This position is ideal for experienced professionals who can engage members, caregivers, and providers to assess and establish individual health goals.

Highlights

• Location: Philadelphia, PA
• Schedule: Full-time, Monday-Friday 8:30am-5:00pm Eastern Time Zone

What You'll Do

• Assess members through face-to-face encounters and by telephone to determine care coordination and care management needs.
• Complete comprehensive person-centered assessments, including physical health history, mental health history, and social determinants of health.
• 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 achieving optimal health.
• Schedule follow-up calls as necessary and make appropriate referrals.
• Document progress towards meeting goals and resolving problems within the EMR system.
• Coordinate care and services with the Community Health Navigator, member caregivers, PCP, specialists, and facility/vendor providers.
• Provide transitional care management and participate in regularly scheduled meetings as needed.

Requirements

Education:

• Current, unrestricted RN license in good standing or unrestricted LMSW/LCSW license with experience in managing medical complexities.

Experience:

• Minimum of 3 to 5 years experience with the physical health population required.
• Experience working with individuals with Medicaid and Medicare populations preferred.
• Case management experience, preferably within a managed care organization, is desired.

Licenses & Certifications:

• Current, unrestricted RN license in good standing or unrestricted LMSW/LCSW license.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k) and tuition reimbursement.

About AmeriHealth Caritas

AmeriHealth Caritas is a leading healthcare provider committed to delivering exceptional patient care. They focus on helping individuals achieve their best health through comprehensive care management and coordination services.