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 Michigan (MI)
- 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
- 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.
- Current, active, and unrestricted Registered Nurse (RN) licensure.
- Valid driver's license with car insurance.
- 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
Vacancy posted 3 hours ago
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