LTSS Care Manager II

AmeriHealth Caritas; Asheboro (NC); On-site; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated LTSS Care Manager II to enhance the health and well-being of members with complex needs. This role involves significant fieldwork, providing care coordination, conducting assessments, and developing personalized service plans. The ideal candidate will be a licensed RN or LCSW with strong clinical and communication skills, capable of navigating healthcare systems and fostering collaboration among care teams. Join a mission-driven organization that values flexibility, competitive compensation, and a commitment to building healthier communities through compassionate care.

Benefits

Flexible Work Options

Comprehensive Benefits

Competitive Pay

Qualifications

• Must hold a current, unrestricted NC LCSW or RN license.
• Experience in case management and with disabled individuals is preferred.

Responsibilities

• Manage and coordinate care for members with complex health needs.
• Conduct assessments and develop comprehensive service plans.
• Collaborate with healthcare professionals and community resources.

Skills

Care Coordination

Clinical Knowledge

Assessment Skills

Communication Skills

Organizational Skills

Education

Master’s in Social Work

Associate Degree in Nursing

Bachelor’s in Nursing

Tools

Electronic Medical Records

MS Office

Job description

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This position will be in the field up to 90% of the time. RN or LCSW required.

Responsibilities

The LTSS Care Manager II 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. The Care Manager schedules appointments, performs face-to-face assessments in various settings including members' homes and community locations, and collaborates with healthcare professionals to develop comprehensive service plans. They serve as the primary point of contact for the care team, including members, physicians, and community supports, to guide members in achieving their optimal level of health.

Utilizing assessment and communication skills, critical thinking, and clinical knowledge, the Care Manager identifies issues, gaps, and barriers to care. They develop a care plan through shared decision-making with the Member/caregiver and in collaboration with providers and other care team members to improve health status, compliance, and self-management. Responsibilities include:

• Supporting Members during transitions of care through assessment, care coordination, education, referrals, and evaluation of the plan's effectiveness.
• Conducting comprehensive assessments to determine PCS eligibility using standardized tools, with assistance from Community Health Navigators.
• Facilitating referrals to Community Health Workers for non-health needs.
• Providing utilization management to ensure timelines and member needs are met.
• Reviewing medication lists, educating Members on pharmacy needs, and counseling on side effects and treatment protocols.
• Monitoring and updating the care plan regularly based on Member progress and preferences.
• Establishing contacts with community, medical, and behavioral health teams.
• Maintaining accurate documentation in electronic care management platforms.
• Monitoring utilization, coordinating services, making referrals, and escalating quality issues.
• Gaining knowledge of care management platforms, policies, and community resources.
• Participating in care management rounds and following up with providers.
• Supporting a positive, collaborative, and culturally competent work environment.
• Performing face-to-face visits at various locations as needed.
• Other duties as assigned.

Education/Experience

• Must be local to Boone, NC.
• Up to 75% travel for home visits and assessments.
• For LCSW: Master’s in social work and current, unrestricted NC LCSW license.
• For RN: Current, unrestricted NC RN license; Associate degree required, Bachelor’s preferred.
• Knowledge of Medicaid and personal care services.
• Experience with assessment and treatment of disabled individuals; experience in medical-surgical, home health, hospice, or adult care environments is desirable.
• Case management experience within managed care preferred.
• Self-directed, adaptable, team-oriented, and culturally competent.
• Strong organizational, time management, and self-management skills.
• Proficiency in MS Office and electronic medical records.
• Valid driver’s license.

Join us in making a difference. We offer flexible work options, competitive pay, comprehensive benefits, and a mission-driven environment focused on building healthier communities.