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Community Care Manager, Pediatric Shift Care, RN
4 months ago
Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care 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 would like to hear you. Headquartered in Newtown Square, 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. Responsibilities: The Community Care Manager, Shift Care assists members appropriate for care coordination and case management services in achieving their optimal level of health. The selected candidate will be responsible for engaging the member 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 an advocate for members in the care coordination program. * Assess members to determine care coordination and case management needs for all referred members. * Conducts in-home physical, psycho-social, and environmental assessments and for complex pediatric members to identify unmet needs, barriers to care, and social determinants of health. * Identifies barriers for care coordination and appropriate care management interventions for pediatric members requiring home care services. 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 both short and long term goals and 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. * Schedules follow up calls/visits 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 member, other family members as appropriate, Pediatric Shift Care team members, Account manager, PCP, Specialist, Facility/Vendor Providers, and community partners. Education/Experience: *
Ability to travel within assigned communities from Delaware County, PA into Philadelphia County, PA. * Current and unrestricted Pennsylvania Registered Nurse license. Bachelor's degree preferred. * Minimum of 3 years of clinical pediatric experience working with medically fragile pediatric patients in acute care and/or home care required. * Experience conducting in-home physical, psycho-social, and environmental assessments for complex pediatric patients strongly preferred. * Case Management experience within a managed care organization preferred. * Proficient in MS Office (Word, Excel, and Outlook) within a Windows-based environment, Internet applications, electronic medical records (EMRs), and electronic documentation programs. * Valid driver's license required and current car insurance required. * Eligible for Certification in Case Management within 12 months of accepting position. Successful attainment of Case Management certification within 18 months of employment required. * Requires completion of medical exam/testing as required by Federal and State regulations upon conditional offer of employment and post-employment. Diversity, Equity, and Inclusion At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy. 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.