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Pediatric Care Manager II, BSN

2 months ago

Philadelphia, Pennsylvania, United States Amerihealth Caritas Health Plan Full time
Pediatric Care Manager II, BSN

Your career begins here. We are in search of the next wave of healthcare innovators.

At AmeriHealth Caritas, we are dedicated to facilitating access to care, promoting wellness, and fostering healthy communities.

As a prominent player in healthcare solutions, we provide our associates with the chance to make a significant impact on the lives of millions through our extensive range of products, services, and acclaimed programs.

AmeriHealth Caritas is on the lookout for skilled, enthusiastic individuals to enhance our workforce. Together, we can cultivate healthier communities. If you are driven to make a difference, we want to hear from you.

Based in Newtown Square, AmeriHealth Caritas is a mission-oriented organization with over three decades of expertise. We deliver comprehensive, outcome-focused care to those who need it most.

We provide integrated managed care products, pharmaceutical benefit management, specialty pharmacy services, behavioral health services, and various administrative solutions.

Learn more about us at

Key Responsibilities:


The Care Manager II supports members who are suitable for care management and coordination services in reaching their optimal health through self-management.

The Care Manager II is tasked with engaging the member, their caregivers, and providers to evaluate, plan, and set individual member objectives.

This role will facilitate and coordinate care for members while ensuring quality and efficient resource utilization.

The position will serve as a single point of contact and advocate for members within the care management program.


  • Evaluate members through in-person meetings or phone calls to ascertain care coordination and management needs for all referred individuals.
  • Conduct comprehensive, person-centered assessments that include physical health history, mental health history, social determinants of health, and support requirements.
  • Coordinate physical, behavioral health, and social services;
  • Oversee medication management, including regular medication reconciliation and support for medication adherence;
  • Identify challenges/barriers for care coordination and implement suitable care management interventions.
  • Develop a care plan to assist members in mitigating/resolving issues and barriers to achieve their optimal health.
  • Establish goals and prioritize them with associated timelines for completion. Share these goals with the member and family as appropriate.
  • Determine and apply the appropriate level of intervention based on the member's needs and clinical progress.
  • Schedule follow-up calls as necessary, make appropriate referrals, and implement actions to address member concerns. Document progress towards achieving goals and resolving issues.
  • Coordinate care and services with the Care Coordinator, Community Health Navigator, members, caregivers, PCPs, specialists, and facility/vendor providers as appropriate.
  • Provide transitional care management. Regularly meet with AMH/CIN regarding identified members for care management, assisting in mitigating/resolving issues and barriers to ensure high-quality care management services.

Qualifications:

  • Bachelor's Degree in Nursing.
  • Current and unrestricted Registered Nurse licensure in Pennsylvania.
  • Minimum of 3 years of clinical experience at the bedside (as a Registered Nurse) working with medically fragile pediatric patients in acute care, home care, or special needs clinics.
  • At least 3 years of Case Management experience, preferably telephonic within a managed care organization, is preferred.
  • Eligible to sit for Case Management certification after 12 months of employment. Must obtain this certification within one year of employment.
  • Demonstrated proficiency in a Windows 11 environment, including MS Office (Excel, Word, Outlook) and electronic medical record/documentation systems.
  • Valid driver's license and car insurance. Must be willing to use a personal vehicle for in-person visits with members as needed.
Diversity, Equity, and Inclusion

At AmeriHealth Caritas, we strive to ensure that everyone feels valued, supported, and free to express themselves. Our commitment to equity guarantees that all associates have a fair opportunity 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.

Embracing the diverse thoughts and perspectives that comprise our workforce enhances our company’s vibrancy, innovation, and ability to support the communities we serve.

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

Our Comprehensive Benefits Package


Flexible work arrangements, including remote options, hybrid schedules, competitive compensation, paid time off for holidays and volunteer activities, health insurance coverage for you and your dependents from Day 1 of employment, 401(k), tuition reimbursement, and more.