Care Manager II

Amerihealth Caritas; Charleston (SC); On-site; USD 60,000 - 90,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Care Manager (RN) to join their mission-driven team. This role is pivotal in assisting members with care coordination and management, ensuring they achieve their optimal health. The Care Manager will engage directly with members, assess their needs, and create personalized care plans while advocating for their well-being. With a commitment to diversity and inclusion, this company offers a supportive environment where every associate can thrive. If you are passionate about making a difference in healthcare, this opportunity is for you.

Benefits

Flexible work solutions

Health insurance coverage from Day 1

401(k)

Tuition reimbursement

Paid time off including holidays

Volunteer events

Qualifications

• Must hold a current and unrestricted RN license in South Carolina.
• 3+ years of professional experience in pediatric home care or acute care.

Responsibilities

• Assist members in achieving optimal health through care management.
• Coordinate care and services with various healthcare providers.

Skills

Care Coordination

Medication Management

Case Management

Patient Advocacy

Communication Skills

Education

BSN

Tools

MS Office

Electronic Medical Record Systems

Job description

Your career starts now. We’re looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we’re 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’d 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.

Responsibilities:

The Care Manager (RN) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager (RN) 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. In addition, the Care Manager will oversee these same care management activities within assigned AMH Tier III/CIN practices to ensure the delivery of high-quality care management services in accordance with Plan, NCQA, Federal/State standards, and requirements.

1. Assess members through face-to-face encounters or by telephone to determine care coordination and care management needs for all referred members.
2. Complete comprehensive, person-centered assessments inclusive of physical health history, mental health history, social determinants of health, and supportive needs.
3. Coordinate physical, behavioral health, and social services.
4. Provide medication management, including regular medication reconciliation and support of medication adherence.
5. Identify problems/barriers for care coordination and appropriate care management interventions.
6. Create a plan of care to assist members in reducing/resolving problems and barriers so that members may achieve their optimal level of health.
7. Identify goals and assign priority with associated time frames for completion. Share goals with the member and family as appropriate.
8. Identify and implement the appropriate level of intervention based on the member’s needs and clinical progress.
9. Schedule follow-up calls as necessary, make appropriate referrals, and implement actions to address member issues. Document progress towards meeting goals and resolving problems.
10. Coordinate care and services with the Care Coordinator, Community Health Navigator, member, caregiver, PCP, Specialist, and Facility/Vendor Providers.
11. Provide transitional care management. Meet regularly with AMH/CIN regarding Plan-identified members for care management, and assist with reducing/resolving problems and barriers to ensure high-quality care management services.
12. Participate in regularly scheduled meetings with the AMH/CIN, including but not limited to JOC meetings as needed.

Education/Experience

• BSN required and must hold a current and unrestricted Registered Nurse (RN) license in good standing in South Carolina or a compact state.
• A minimum of 3 years of professional experience in pediatric home care or acute care is required.
• Prior experience in the Foster Care System, Department of Social Services, or Department of Juvenile Justice as an RN is preferred.
• Must engage directly with identified members through face-to-face visits in the community as needed.
• At least 3 years of case management experience is preferred.
• Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record/documentation systems is essential.
• A valid driver’s license with car insurance is required.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable being 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 makes our company more vibrant, innovative, and better equipped to support the people and communities we serve.

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.