Care Manager II

Role Overview: Care Manager II (Field-Based, Remote)

Responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex, and behavioral health conditions and other health needs. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care and barriers to care. The Care Manager II develops a plan of care through shared decision making with the Member/caregiver and in collaboration with providers and other care team members to improve the Member's health status, compliance with treatment plans and promote self-management.


Responsibilities:

• Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the effectiveness of the plan
• Review medication list and educate Members with pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols
• Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the Member/caregiver progress, needs and preferences
• Establishes points of contact in order to collaborate with identified community, medical, and/or behavioral health teams
• Maintain timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable
• Monitor appropriate utilization and coordinate services with other payer sources, make appropriate referrals, identify and escalate quality of care issues.
• Develop a working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements
• May identify cases to be presented at care management rounds and follows up with providers on recommendations to achieve optimal outcomes for Members
• Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support our culturally and demographically diverse Member population
• Face-to-face visits may be required at the Member's residence, provider's office, hospitals, behavioral health facilities, and other acute location or community location for education and/or assessment.

Education and Experience:

• Bachelor of Science in Nursing (BSN) is required.
• Minimum of 3 years of professional experience in related field required (i.e., pediatrics, home care, acute care, etc.)
• Prior experience in the Foster Care System, Department of Social Services, or Department of Juvenile Justice as an RN is preferred
• Must engage directly with identified members through face-to-face visits in the community as needed
• At least 3 years of case management experience is preferred
• Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record/documentation systems is essential

Licensure:

• Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South Carolina or a compact state
• Travel required. Must have valid driver's license, reliable transportation and auto insurance.

Our Comprehensive Benefits Package:
Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.

Why Join Us: Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are 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 are driven to make a difference, we want to hear from you.

About AmeriHealth Caritas
Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at