Care Manager II, Pediatrics, RN

AmeriHealth Caritas; Philadelphia (Philadelphia County); Hybrid; USD 50,000 - 80,000; Full time

Job summary

Join a mission-driven organization dedicated to improving healthcare outcomes for vulnerable populations. As a Care Manager, you will play a pivotal role in helping members navigate their healthcare journey, ensuring they receive the necessary support and resources to achieve optimal health. This position offers a unique opportunity to impact lives through personalized care coordination, working closely with members, their families, and healthcare providers. With flexible work options and a commitment to diversity, equity, and inclusion, this role is perfect for passionate individuals ready to make a difference in their communities.

Benefits

Flexible work options

Health insurance from Day 1

401(k)

Tuition reimbursement

Paid time off

Volunteer events

Competitive pay

Qualifications

• 3+ years of clinical experience with pediatric patients.
• Current Registered Nurse licensure in Pennsylvania is required.

Responsibilities

• Assess members to determine care coordination needs.
• Create and implement care plans to assist members in achieving health goals.
• Coordinate care with healthcare providers and community resources.

Skills

Care Coordination

Clinical Assessment

Medication Management

Case Management

Communication Skills

Education

Associate Degree in Nursing

Bachelor of Science in Nursing

Tools

MS Office

Electronic Medical Records

Windows 11

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, 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.

Position: Care Manager

The Care Manager assists enrollees appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager is responsible for engaging the member, member caregivers, 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 functions as a single point of contact and advocate for members in the care coordination program, overseeing activities within assigned practices to ensure high-quality care management services in accordance with Plan, NCQA, Federal/State standards and requirements.

Responsibilities:

1. Assess members 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 to achieve their health goals.
7. Identify goals and set priorities with associated time frames; share goals with the member and family as appropriate.
8. Implement appropriate levels of intervention based on the member’s needs and clinical progress.
9. Schedule follow-up calls, make referrals, and implement actions to address member issues.
10. Document progress towards goals and problem resolution.
11. Coordinate care and services with the Community Health Navigator, members, caregivers, PCPs, specialists, and providers.
12. Participate in regular meetings with partners regarding Plan-identified members for care management.

Education & Experience:

• Must reside in Pennsylvania.
• Associate Degree in Nursing required; Bachelor of Science in Nursing preferred.
• Current and unrestricted Registered Nurse licensure in Pennsylvania.
• 3+ years of clinical experience working with medically fragile pediatric patients in acute care, home care, or special needs clinics.
• 3+ years of case management experience, preferably telephonic within a managed care organization.
• Proficiency in Windows 11 environment, MS Office, and electronic medical records.
• Valid driver’s license and car insurance; willingness to drive a personal vehicle for work-related events.
• Ability to work Monday-Friday from 8:30 am to 5:00 pm EST.

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. Celebrating diverse perspectives makes our company more vibrant, innovative, and better equipped to serve our communities.

Benefits:

Flexible work options including remote and hybrid schedules, competitive pay, paid time off including holidays and volunteer events, health insurance coverage from Day 1, 401(k), tuition reimbursement, and more.