Care Manager II

AmeriHealth Caritas; North Charleston (SC); On-site; USD 65,000 - 85,000; Full time

Job summary

A leading healthcare organization is seeking a Care Manager (RN) to support members in achieving their health goals through effective care coordination. The role involves assessing needs, creating care plans, and collaborating with various healthcare providers. The ideal candidate will have a BSN and experience in case management, ensuring high-quality care for members. Join us to make a meaningful impact in the community and enjoy benefits like flexible work options and health insurance from Day 1.

Benefits

Flexible work options

Competitive pay

Paid time off

Health insurance from Day 1

401(k)

Tuition reimbursement

Qualifications

• Minimum of 3 years of professional experience in pediatric home care or acute care.
• At least 3 years of case management experience preferred.

Responsibilities

• Assist members in achieving optimal health through self-management.
• Coordinate care for members while assuring quality and cost-effective resources.
• Complete comprehensive, person-centered assessments.

Skills

Communication

Care Coordination

Problem Solving

Education

BSN

Tools

MS Office

Electronic Medical Records

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.
• Assess members through face-to-face encounters or by telephone to determine care coordination and care management needs for all referred members.
• Complete comprehensive, person-centered assessments 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 and barriers for care coordination and appropriate interventions.
• Create a plan of care to assist members in reducing or resolving problems and barriers to achieve their health goals.
• Identify goals, set priorities, and assign time frames for completion. Share goals with the member and family as appropriate.
• Implement appropriate levels of intervention based on the member’s needs and progress.
• Schedule follow-up calls, make referrals, and document progress towards goals.
• Coordinate care with the Care Coordinator, Community Health Navigator, members, caregivers, PCPs, specialists, and providers.
• Provide transitional care management and participate in scheduled meetings with AMH/CIN to ensure high-quality care management services.

Education/Experience:

• BSN required and must hold a current, unrestricted RN license in South Carolina or a compact state.
• Minimum of 3 years of professional experience in pediatric home care or acute care.
• Experience in Foster Care System, Department of Social Services, or Juvenile Justice as an RN is preferred.
• Engage directly with members through face-to-face visits as needed.
• At least 3 years of case management experience preferred.
• Proficiency in MS Office, internet applications, and electronic medical records.
• A valid driver’s license with 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 act with integrity and respect, stand against injustice, and support a more inclusive workplace. We celebrate diverse perspectives to make our company more vibrant and innovative.

Our Benefits:

Flexible work options, competitive pay, paid time off, health insurance from Day 1, 401(k), tuition reimbursement, and more.