Pediatric Care Management RN II

2 weeks ago


Philadelphia, Pennsylvania, United States AmeriHealth Caritas Full time
Position Overview:
The Pediatric Care Manager II is dedicated to assisting members eligible for care management and coordination services in achieving their highest level of health through effective self-management.

Key Responsibilities:
  • Engage with members, their caregivers, and healthcare providers to assess, plan, and establish personalized health goals.
  • Facilitate and coordinate care while ensuring quality and cost-effective resource utilization.
  • Act as a single point of contact and advocate for members within the care management program.
  • Conduct telephonic assessments to identify care coordination and management needs.
  • Complete comprehensive, person-centered assessments, including physical health history, mental health history, and social determinants of health.
  • Coordinate physical, behavioral health, and social services.
  • Provide medication management, including regular medication reconciliation and support for adherence.
  • Identify barriers to care coordination and implement appropriate interventions.
  • Create individualized care plans to assist members in overcoming challenges and achieving optimal health.
  • Set goals with defined priorities and timelines, sharing them with members and their families as appropriate.
  • Schedule follow-up communications as necessary and make appropriate referrals.
  • Document progress towards goals and resolution of issues.
  • Collaborate with Care Coordinators, Community Health Navigators, and other healthcare providers to ensure comprehensive care.

Qualifications:
- Bachelor's Degree in Nursing.
- Current and unrestricted Registered Nurse licensure in Pennsylvania.
- A minimum of 3 years of clinical experience as a Registered Nurse, specifically with medically fragile pediatric patients in various care settings.
- At least 3 years of experience in Case Management, preferably in a telephonic capacity within a managed care environment.
- Proficiency in using Windows 11 and MS Office applications, as well as electronic medical record systems.
- Valid driver's license and car insurance, with willingness to travel for work-related purposes.

Diversity, Equity, and Inclusion:
At AmeriHealth Caritas, we value diversity and strive to create an inclusive environment where all associates can thrive. Our commitment to equity ensures that everyone has the opportunity to reach their full potential. We actively promote respect and integrity in our workplace, supporting a culture that embraces diverse perspectives and experiences.

Benefits:
We offer a comprehensive benefits package that includes flexible work solutions, competitive compensation, health insurance coverage from Day 1, 401(k) plans, tuition reimbursement, and more.

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