Community Care Manager Sr

AmeriHealth Caritas

Role Overview: The Senior Community Care Manager supports members in community-based care coordination and case management programs while collaborating across the Medical Management department to ensure alignment with organizational initiatives and strategic goals.

Work Arrangements:

Remote - Associate must reside in the state of Michigan (MI); preferred counties include Wayne, Oakland, and Macomb.

Responsibilities:

Serves as a single point of contact for member questions in collaboration with telephonic care managers and the Community Care Management Team (CCMT)
Conducts in-home environmental and physical assessments for high-risk members to identify unmet needs and barriers to care
Develops and maintains individualized care plans, ensuring they are regularly reviewed and updated
Provides disease self-management education and coaching within the scope of practice
Performs medication reviews, including reconciliation during transitions of care
Coordinates care across settings to ensure services are delivered in the least restrictive environment and supports transitions between care levels
Connects members to community, medical, and behavioral health resources to address barriers and support independent living
Collaborates with and oversees Community Care Connectors to facilitate access to in-community support services
Serve as a subject matter expert and supports leadership with operational activities, including training, mentoring, workflow coordination, referral review, and case assignment
Maintains a caseload and provides coverage for team members as needed to ensure continuity of care
Acts as a clinical and operational resource to address member needs and resolve complex issues
Ensures compliance with workflows, documentation standards, and regulatory requirements, including National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC) standards

Education & Experience:

Bachelor's degree in nursing required.
Current, active, and unrestricted Registered Nurse (RN) licensure.
3 plus years of case management experience.
1 year of community care management experience.
Home Health RN experience preferred
Certification as a Case Manager within 2 years of hire.

Licensure:

Current, active, and unrestricted Registered Nurse (RN) licensure.
Valid driver's license with car insurance.

Skills & Abilities:

Strong clinical assessment skills with the ability to evaluate member needs and identify barriers to care
Strong communication and interpersonal skills, with the ability to engage members and collaborate with interdisciplinary teams
Ability to educate and coach members on disease management and self-care strategies
Critical thinking and problem-solving skills to address complex member needs and resolve care issues
Strong organizational and time management skills
Ability to collaborate with and provide guidance to team members
Knowledge of healthcare regulations, accreditation standards, and compliance
Proficiency with documentation systems, care management platforms, and Microsoft Office tools

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Vacancy posted 3 days ago

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