Care Manager II

AmeriHealth Caritas; Philadelphia (Philadelphia County); Hybrid; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare solutions provider is seeking a Care Manager II responsible for supporting members in achieving optimal health through effective care coordination and individual goal setting. Candidates should possess a Bachelor's Degree in Nursing, an active RN license, and relevant case management experience. The role involves direct engagement with members and providers to ensure high-quality and cost-effective care, aligning with federal and state standards.

Benefits

Flexible work solutions including remote options

Competitive pay and paid time off

Health insurance coverage from Day 1

401(k) tuition reimbursement

Qualifications

• 3 years of professional practice with RN license required.
• 3 to 5 years of case management experience.
• Pediatric experience required.

Responsibilities

• Conduct assessments to determine care coordination needs.
• Develop care plans to help members achieve health goals.
• Document progress towards goals and manage medication adherence.

Skills

Care Coordination

Assessment Skills

Communication

Problem Solving

Intervention Implementation

Education

Bachelor’s Degree in Nursing (RN)

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, 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.

Discover more about us atwww.amerihealthcaritas.com.

Position Overview: The Care Manager II supports members in achieving optimal health through self-management. Engaging with members, caregivers, and providers, the role involves assessing plans, setting individual goals, and coordinating care to ensure quality and cost-effective resources. This position serves as a single point of contact and advocate for care coordination program members, overseeing care management activities within assigned practices to meet Plan, NCQA, Federal/State standards.

Key Responsibilities:

• Conduct telephone assessments to determine care coordination and management needs.
• Complete comprehensive person-centered assessments covering physical and mental health history, social determinants, and supportive needs.
• Coordinate physical, behavioral health, and social services.
• Manage medications, including reconciliation and adherence support.
• Identify problems/barriers and implement appropriate care management interventions.
• Develop care plans to help members achieve optimal health, setting goals and priorities.
• Share goals with members and families as appropriate.
• Implement interventions based on member needs and clinical progress.
• Schedule follow-up calls and make referrals as necessary.
• Document progress towards goals and problem resolution.
• Coordinate care with Community Health Navigators, caregivers, PCPs, specialists, and facility/vendor providers.
• Meet regularly with partners to address care management issues and ensure high-quality services.
• Participate in scheduled meetings as needed.

Education & Qualifications:

• Bachelor’s Degree in Nursing (RN) required.
• 3 years of professional practice experience with an active state RN license.
• 3 to 5 years of case management experience
• Pediatric experience required
• Home health nursing experience preferred

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 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 include remote options, hybrid work schedules, competitive pay, paid time off, 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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