Pediatric Care Management RN II

2 weeks ago

Philadelphia, Pennsylvania, United States Amerihealth Caritas Health Plan Full time
Pediatric Care Management RN II

Your professional journey begins here. We are in search of innovative health care leaders.

At AmeriHealth Caritas, we are dedicated to assisting individuals in accessing care, maintaining wellness, and fostering healthy communities.

As a prominent provider in health care solutions, we empower our team members to make a significant impact on the lives of countless individuals through our extensive range of products, services, and acclaimed programs.

AmeriHealth Caritas is on the lookout for skilled, enthusiastic professionals to enhance our organization. Together, we can cultivate healthier communities. If you are eager to make a positive impact, we would love to connect with you.

As a mission-driven organization based in Newtown Square, AmeriHealth Caritas boasts over 30 years of expertise. We provide comprehensive, outcome-focused care to those who require it the most.

Our offerings include integrated managed care products, pharmaceutical benefit management, specialty pharmacy services, behavioral health services, and various administrative support services.

Learn more about our mission at

Key Responsibilities:


The Care Manager II plays a crucial role in assisting members eligible for care management and coordination services to reach their highest potential for health through self-management.

This position involves engaging with members, their caregivers, and providers to evaluate, plan, and set personalized goals for each member.

The Care Manager II will facilitate and coordinate care for members while ensuring quality and the efficient use of resources.

This role serves as a primary contact and advocate for members within the care management program.


  • Conduct assessments of members through in-person meetings or phone calls to identify care coordination and management needs for all referred individuals.
  • Complete a thorough, person-centered assessment that includes physical health history, mental health history, social determinants of health, and supportive needs.
  • Coordinate services across physical health, behavioral health, and social services;
  • Manage medications, including regular reconciliation and support for adherence;
  • Identify challenges and barriers to care coordination and implement suitable care management interventions.
  • Develop a care plan to assist members in overcoming challenges and achieving their optimal health.
  • Set goals and prioritize them with associated timelines for completion, sharing these goals with members and their families as appropriate.
  • Determine and apply the necessary level of intervention based on the member's needs and clinical progress.
  • Schedule follow-up calls as needed, make appropriate referrals, and take action to address member concerns. Document progress towards goals and resolution of issues.
  • Collaborate with Care Coordinators, Community Health Navigators, members, caregivers, PCPs, specialists, and facility/vendor providers to ensure coordinated care.
  • Provide transitional care management. Regularly meet with relevant teams regarding identified members for care management, assisting in resolving issues to deliver high-quality care management services.

Qualifications:

  • Bachelor's Degree in Nursing.
  • Current and valid Registered Nurse licensure in Pennsylvania.
  • Minimum of 3 years of clinical experience as a Registered Nurse, specifically with medically fragile pediatric patients in acute care, home care, or specialized clinics.
  • At least 3 years of experience in Case Management, preferably in a telephonic capacity within a managed care setting.
  • Eligible to pursue Case Management certification after 12 months of employment, with a requirement to obtain certification within one year.
  • Proficient in operating within a Windows 11 environment, including MS Office (Excel, Word, Outlook) and electronic medical record systems.
  • A valid driver's license and car insurance are required. Willingness to use a personal vehicle for in-person member visits as necessary.
Diversity, Equity, and Inclusion

At AmeriHealth Caritas, we strive to create an environment where everyone feels valued, supported, and free to express themselves. Our commitment to equity ensures that all associates have equal opportunities to reach their full potential. We embody these principles daily by acting with integrity and respect.

We unite to advocate against injustice and dismantle barriers to foster a more inclusive and equitable workplace.

By celebrating and embracing the diverse perspectives that constitute our workforce, we enhance our organization’s vibrancy, innovation, and ability to serve the communities we support.

We prioritize the well-being of our associates so they can focus on the health of our members.

Our Comprehensive Benefits Package


We offer flexible work solutions, including remote options, hybrid schedules, competitive compensation, paid time off for holidays and volunteer activities, health insurance coverage from Day 1, 401(k) plans, tuition reimbursement, and more.

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