Care Manager

AmeriHealth Caritas; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

AmeriHealth Caritas is seeking a Care Manager to manage and coordinate care for members with diverse health needs. This remote role requires strong assessment and communication skills, fostering collaboration with healthcare teams. The ideal candidate will have nursing or social work qualifications and experience in healthcare settings, contributing to improved member outcomes.

Benefits

Flexible work solutions including remote options

Competitive pay

Paid time off including holidays and volunteer events

Health insurance coverage from Day 1

401(k) with company match

Tuition reimbursement

Qualifications

• Current, unrestricted Ohio RN license or Ohio LCSW license.
• Minimum of 3 years of experience in acute care or community health.
• Knowledge in assessing member situations and developing care plans.

Responsibilities

• Manage and coordinate care for members with complex health conditions.
• Educate members on medication and treatment plans.
• Document member interactions accurately in electronic systems.

Skills

Assessment skills

Communication skills

Critical thinking

Organizational skills

Time management

Education

Associate degree in nursing

Bachelor’s degree in nursing (preferred)

Master’s degree in social work

Tools

MS Office (Word, Excel, Outlook, Teams)

Electronic medical record programs

Job description

Role Overview

The Care Manager is responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex and/or behavioral health conditions and other health needs. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care and barriers to care. The Care Manager II develops a plan of care through shared decision making with the Member/caregiver and in collaboration with providers and other care team members to improve the Member’s health status, compliance with treatment plans and promote self-management.;

Work Arrangement

• Remote

Responsibilities:

• Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the effectiveness of the plan
• Review medication list and educate Members with pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols
• Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the Member/caregiver progress, needs and preferences
• Establishes points of contact to collaborate with identified community, medical, and/or behavioral health teams
• Maintain timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable
• Monitor appropriate utilization and coordinate services with other payer sources, make appropriate referrals, identify, and escalate quality of care issues
• Develop a working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements
• May identify cases to be presented at care management rounds and follows up with providers on recommendations to achieve optimal outcomes for Members
• Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support our culturally and demographically diverse Member population. Face-to-face visits may be required at the Member’s residence, provider’s office, hospitals, other acute location or community location for education and/or assessment
• Other duties as assigned

Education and Experience

• Requirements for RN: Current, unrestricted Ohio RN license in good standing. Associate degree in nursing required. Bachelor’s degree preferred
• Requirements for LMSW: Master’s degree in social work and current, unrestricted Ohio LCSW license in good standing
• Minimum of 3 years of professional practice working with adults and/or pediatric patients with behavioral and physical health disorders within an acute care, community health, or ambulatory care setting
• Case management experience, preferably within a managed care organization, desired
• Demonstrate ability to be self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team in a fast-paced, ever-changing environment.
• Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population
• Demonstrate strong organizational and time management skills with the ability to prioritize and follow through on multiple items in a timely manner
• Demonstrate knowledge and experience in assessing Member’s situation, developing a care plan, and teaching self-management
• Proficiency using MS Office (Word, Excel, Outlook, Teams), SharePoint, internet applications, and electronic medical record and documentation programs

Licensure

• Valid driver’s license and car insurance
• Current, unrestricted Ohio RN license in good standing or unrestricted Ohio LCSW license in good standing

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 nation's 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 connect with you.

Headquartered in Newtown Square, 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.

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, 401(k) Tuition reimbursement and more.

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