Pediatric Care Manager II

AmeriHealth Caritas; Charlotte (NC); Remote; USD 55,000 - 109,000; Full time

Job summary

AmeriHealth Caritas seeks a Care Manager (RN/LCSW) to join their team in Charlotte, NC, focusing on coordinating healthcare services for pediatric populations. The role involves assessing patient needs, collaborating with healthcare providers, and ensuring quality care management. Ideal candidates have a Master's in Social Work or Nursing and relevant experience in coordinated care.

Benefits

Flexible work solutions including remote options

Competitive pay and health insurance coverage

Paid time off including holidays

401(k) Tuition reimbursement

Qualifications

• 3 years of professional practice experience required.
• 3 to 5 years of case/care management preferred.
• Active state Clinical Social Work license.

Responsibilities

• Assess members to determine care management needs.
• Coordinate physical, behavioral health, and social services.
• Create care plans to assist members in achieving optimal health.

Skills

Care Coordination

Patient Advocacy

Medication Management

Education

Master’s Degree in Social Work

Registered Nurse License

Job description

2 days ago Be among the first 25 applicants

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.;

Role Overview

The Care Manager (RN/LCSW) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager (RN/LCSW) 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 AMH Tier III/CIN delivers high quality care management services in accordance with Plan, NCQA, Federal/State standards and requirements.

Work Arrangement

• Must reside in NC.
• This is a remote position covering Charlotte area and surrounding counties.
• This position has a focus on the pediatric population.
• May require occasional travel
  
  

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Responsibilities

• Assess members through face-to-face encounter or by telephone to determine care coordination and care management needs for all referred members.
• Completes comprehensive person-centered assessment inclusive of physical health history, mental health history, social determinants of health and supportive needs.
• Coordinates physical, behavioral health and social services.
• Provides medication management, including regular medication reconciliation and support of medication adherence.
• Identifies problems/barriers for care coordination and appropriate care management interventions.
• Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health.
• Identifies goals and assigns priority with associated time frames for completion. Shares goals with the member and family as appropriate.
• Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress.
• Schedules follow up calls as necessary, makes appropriate referrals. Implements actions to address member issues. Documents progress towards meeting goals and resolving problems.
• Coordinates care and services with the Care Coordinator, Community Health Navigator, and member, member care giver as appropriate, PCP, Specialist, and Facility/Vendor Providers.
• Provides transitional care management. Meets regularly with AMH/CIN regarding Plan identified members for care management, assist with reducing/resolving problems and or barriers so that the AMH/CIN may provide members with high quality care management services.
• Participate in regularly scheduled meetings with the AMH/CIN including but not limited to JOC meetings as needed.
  
  

Education/Experience

• Master’s Degree in SW. ;
• Registered Nurse.
• 3 years professional practice experience.
• 3 to 5 years of Case/Care Management preferred.
  
  

Licensure

• ;Valid driver’s license with car insurance.
• Active state Clinical Social Work license.
  
  

;

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.

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Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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